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General NPI Number Information
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NPI Number | 1992872923
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Entity Type | Individual
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Provider Name | MARK LOWELL OSADCHEY R.P.T.
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Gender | Male
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3310 VALENCIA DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7502
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Country | US
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Telephone | 208-520-4041
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Fax | 208-745-9477
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Provider Business Mailing Address
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Address Line | PO BOX 3914
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City | IDAHO FALLS
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State | ID
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Zip | 83403-3914
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Country | US
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Telephone | 208-520-4041
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Fax | 208-745-9477
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | PT-1001
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License Number State | ID
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