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General NPI Number Information
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NPI Number | 1982580452
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Entity Type | Organization
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Legal Business Name | POWER BASIN THERAPY LLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 1675 E RIVERSIDE DR STE 200
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City | EAGLE
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State | ID
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Zip | 83616-7473
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Country | US
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Telephone | 208-207-2726
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Fax |
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Provider Business Mailing Address
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Address Line | 101 W. CROOK STREET
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City | MORECROFT
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State | WY
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Zip | 82721
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Country | US
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Telephone | 307-756-9200
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Fax | 307-756-9203
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Authorized Official
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Title or Position | SECRETARY
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Name | AMBER TUELLER
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Credential |
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Telephone | 208-207-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #4
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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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