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General NPI Number Information
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NPI Number | 1851457675
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Entity Type | Organization
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Legal Business Name | FOOTHILLS PHYSICAL THERAPY PA
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1618 MILLENIUM WAY SUITE 210
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City | MERIDIAN
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State | ID
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Zip | 83642-6439
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Country | US
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Telephone | 208-884-4647
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 W SHORELINE DR SUITE 230
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City | BOISE
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State | ID
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Zip | 83702-6730
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Country | US
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Telephone | 208-343-4700
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Fax | 208-343-4706
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Authorized Official
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Title or Position | SECRATARY
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Name | MR. BROOKS ABERG
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Credential | PT
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Telephone | 208-343-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | ID
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