# IDAHO PHYSICAL MEDICINE & REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** IDAHO PHYSICAL MEDICINE & REHABILITATION
- **Other names:** PA Grp
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1497969604
- **Legal business name:** IDAHO PHYSICAL MEDICINE & REHABILITATION
- **Authorized official:** MS. SHARON A LEE (ADMINISTRATOR)
- **Authorized official phone:** (208) 489-5160

## Contact information

- **Practice address:** 600 ROBBINS RD, BOISE, ID 83702-4539
- **Practice address phone:** (208) 489-4016
- **Practice address fax:** (208) 489-4015
- **Mailing address:** 600 N. ROBBINS RD, BOISE, ID 83702
- **Mailing address phone:** (208) 489-4016
- **Mailing address fax:** (208) 489-4015

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | NULL | Yes |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2007
- **Last updated:** 03/16/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 80746780 | — | ID |