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General NPI Number Information
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NPI Number | 1861254278
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Entity Type | Organization
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Legal Business Name | DUPONT WELLNESS PLLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 1460 E SHENANDOAH DR
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City | BOISE
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State | ID
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Zip | 83712-6657
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Country | US
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Telephone | 208-570-3004
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Fax | 208-252-6297
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Provider Business Mailing Address
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Address Line | 1460 E SHENANDOAH DR
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City | BOISE
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State | ID
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Zip | 83712-6657
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Country | US
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Telephone | 208-570-3004
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Fax | 208-252-6297
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Authorized Official
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Title or Position | OWNER, PHYSICAL THERAPIST
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Name | DR. COREY DUPONT
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Credential | PT
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Telephone | 208-570-3004
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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