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General NPI Number Information
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NPI Number | 1962488205
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Entity Type | Individual
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Provider Name | SCOTT R BLOXHAM P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1224 8TH ST STE A
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City | RUPERT
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State | ID
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Zip | 83350-1527
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Country | US
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Telephone | 208-436-9016
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Fax | 208-436-4922
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Provider Business Mailing Address
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Address Line | 545 CEDAR DR
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City | BURLEY
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State | ID
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Zip | 83318-2821
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Country | US
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Telephone | 208-878-9274
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Fax | 208-436-4922
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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 | RPT-085
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License Number State | ID
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