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General NPI Number Information
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NPI Number | 1851011019
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Entity Type | Individual
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Provider Name | JAMILYN MARIE FASTH PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 4424 E FLAMINGO AVE STE 120
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City | NAMPA
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State | ID
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Zip | 83687-9291
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Country | US
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Telephone | 208-205-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 3369 S HOLDEN AVE
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City | BOISE
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State | ID
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Zip | 83706-5395
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Country | US
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Telephone | 208-559-4791
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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 | PT-7221
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License Number State | ID
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