MEDICARE: MOUNTAIN VIEW PHYSIATRY

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	2081N0008X	Neuromuscular Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1760263883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VIEW PHYSIATRY

Provider Business Mailing Address
First Line	:	1869 E SELTICE WAY # 531
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-7019
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 E POLELINE AVE
Second Line	:
City	:	POST FALLS
State	:	ID
Zip	:	83854-6150
Country	:	US
Telephone Number	:	208-777-5511
Fax Number	:	724-426-8936

Authorized Official
Title or Position	:	PHYSICIAN/CO-OWNER
Name	:	DR. NEILLY BUCKALEW
Credential	:	MD
Telephone Number	:	208-777-5511

Provider Enumeration Date	:	10/13/2023
Last Update Date	:	12/18/2023

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Directions to “MOUNTAIN VIEW PHYSIATRY ” Practice Location

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