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Organization
TETON OUTPATIENT, LLC
Active
Organization
TETON OUTPATIENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACOB RAYMOND BRYAN MOT (OWNER)
(208) 419-0896
Entity
Organization
Contact information
Practice address
403 1ST ST, IDAHO FALLS, ID 83401-3928
(208) 419-0896
(208) 419-0974
Mailing address
403 1ST ST, IDAHO FALLS, ID 83401-3928
(208) 419-0896
(208) 419-0974
Taxonomy
Speciality
Code
Description
License number
State
261QR0400X
Rehabilitation Clinic/Center
Primary
—
NULL
Other
Enumeration date
10/12/2011
Last updated
10/12/2011
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