# RENAISSANCE REHAB

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821491424
- **Authorized official:** MR. JAMES A KING MS, OTR/L (OWNER)
- **Authorized official phone:** (208) 339-7234

## Contact information

- **Practice address:** 4846 WIND RIVER RD, IDAHO FALLS, ID 83401-5828
- **Practice address phone:** (208) 339-7234
- **Practice address fax:** (208) 552-0395
- **Mailing address:** 4846 WIND RIVER RD, IDAHO FALLS, ID 83401-5828
- **Mailing address phone:** (208) 339-7234
- **Mailing address fax:** (208) 552-0395

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | PT-1398 | ID | — |
| 225X00000X | Occupational Therapist | OT-843 | ID | Yes |

## Other

- **Enumeration date:** 09/27/2014
- **Last updated:** 09/27/2014