Organization
GRIDIRON REHAB AND ATHLETIC FITNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC TAMURA (ADMINISTRATOR / MANAGING EMPLOYEE)
(208) 887-8684
Entity
Organization
Contact information
Practice address
3035 W MCMILLAN RD, SUITE 104, MERIDIAN, ID 83646
(208) 887-8684
(208) 887-9226
Mailing address
3035 W MCMILLAN RD, SUITE 104, MERIDIAN, ID 83646-6163
(208) 887-8684
(208) 887-9226
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808389100
—
ID
01
—
T9390
BLUE CROSS
ID
Enumeration date
02/25/2009
Last updated
05/17/2018
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