Individual
PHARES BRIGGS HORMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
3456 E 17TH ST, SUITE 130, AMMON, ID 83406-6757
(208) 523-0030
Mailing address
3456 E 17TH ST, SUITE 130, AMMON, ID 83406-6757
(208) 523-0030
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-727
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010152186
BLUE SHIELD GROUP NUMBER
ID
01
—
000010152190
BLUE SHIELD INDIV. NUMBER
ID
01
—
8M467
BLUE CROSS GROUP NUMBER
ID
01
—
TD207
BLUE CROSS INDIVIDUAL #
ID
Enumeration date
11/09/2006
Last updated
05/06/2025
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