Organization
BRYANT BELNAP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON SCROGHAM (OFFICE MANAGER)
12085224481
Entity
Organization
Contact information
Practice address
3345 MERLIN DR, SUITE 100, IDAHO FALLS, ID 83404-7405
(120) 852-2448
(120) 852-2613
Mailing address
3345 MERLIN DR, SUITE 100, IDAHO FALLS, ID 83404-7405
(120) 852-2448
(120) 852-2613
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-343
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001244100
—
ID
Enumeration date
04/14/2008
Last updated
06/18/2008
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