MEDICARE: MRS. BRIDGET CATHERINE CHOW P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	417	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010019416	OTHER	ID	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	T3936	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1063418796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRIDGET CATHERINE CHOW P.T.

Provider Business Mailing Address
First Line	:	5255 OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-2637
Country	:	US
Telephone Number	:	208-338-9486
Fax Number	:	208-338-9586

Provider Business Practice Location Address
First Line	:	5255 OVERLAND RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83705-2637
Country	:	US
Telephone Number	:	208-338-9486
Fax Number	:	208-338-9586

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	06/18/2008

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Directions to “ MRS. BRIDGET CATHERINE CHOW P.T.” Practice Location

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