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General NPI Number Information
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NPI Number | 1821884826
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Entity Type | Individual
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Provider Name | ETHAN MCCARVER DPT
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Gender |
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 4842 N CORTONA WAY STE 100
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City | MERIDIAN
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State | ID
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Zip | 83646-1913
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Country | US
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Telephone | 208-888-8306
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Fax | 208-369-9272
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Provider Business Mailing Address
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Address Line | 7979 W RIFLEMAN ST STE 200
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City | BOISE
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State | ID
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Zip | 83704-9066
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Country | US
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Telephone | 208-377-3850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1371259
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License Number State | ID
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