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General NPI Number Information
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NPI Number | 1881804169
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REHABILITATION NETWORK, INC.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 319 8TH AVE N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6351
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Country | US
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Telephone | 208-539-4776
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Fax |
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Provider Business Mailing Address
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Address Line | 319 8TH AVE N
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City | TWIN FALLS
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State | ID
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Zip | 83301-6351
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Country | US
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Telephone | 208-539-4776
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | NOAH MILLER
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Credential | PT
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Telephone | 208-539-4776
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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 | RPT-1361
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License Number State | ID
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