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NPI Code Detail

MEDICARE: BOISE BRAIN AND BODY LLC

MEDICARE: BOISE BRAIN AND BODY LLC
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
12081P0301XBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number : 1073403051
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOISE BRAIN AND BODY LLC
Provider Business Mailing Address
First Line : 6568 S FEDERAL WAY # 238
Second Line :
City : BOISE
State : ID
Zip : 83716-9277
Country : US
Telephone Number : 818-861-6481
Fax Number :
Provider Business Practice Location Address
First Line : 711 N CURTIS RD
Second Line :
City : BOISE
State : ID
Zip : 83706-1445
Country : US
Telephone Number : 208-605-3000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : EDWARD A ANTON
Credential :
Telephone Number : 818-861-6481
Provider Enumeration Date : 07/09/2025
Last Update Date : 06/17/2026

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Directions to “BOISE BRAIN AND BODY LLC ” Practice Location

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