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General NPI Number Information
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NPI Number | 1881938777
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Entity Type | Organization
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Legal Business Name | NORTH STAR PHYSICAL THERAPY AND WELLNESS
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Dates
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Enumeration Date | 11/16/2012
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Last Update Date | 11/16/2012
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Provider Practice Location Address
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Address Line | 8944 N. HESS ST SUITE B
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City | HAYDEN
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State | ID
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Zip | 83835
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Country | US
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Telephone | 208-762-0251
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Fax | 208-762-0252
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Provider Business Mailing Address
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Address Line | 8944 N. HESS ST SUITE B
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City | HAYDEN
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State | ID
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Zip | 83835-9691
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Country | US
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Telephone | 208-762-0251
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Fax | 208-762-0252
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MR. JASON WILLIAM BRUNS
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Credential | P.T.
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Telephone | 208-659-6327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT1877
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License Number State | ID
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