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General NPI Number Information
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NPI Number | 1831730118
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Entity Type | Organization
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Legal Business Name | FALLS MEDICAL AESTHETICS, PLLC
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Dates
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Enumeration Date | 10/08/2019
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Last Update Date | 11/29/2020
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Provider Practice Location Address
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Address Line | 3760 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7593
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Country | US
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Telephone | 208-881-5779
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Fax |
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Provider Business Mailing Address
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Address Line | 3760 WASHINGTON PKWY
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7593
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Country | US
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Telephone | 208-881-5779
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANTHONY RIETH
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Credential |
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Telephone | 208-716-4741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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