Individual
AUSTIN STODDARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
1263 BENNETT AVE STE 2, BURLEY, ID 83318-4906
(208) 678-1191
Mailing address
1263 BENNETT AVE STE 2, BURLEY, ID 83318-4906
(208) 678-1191
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-8373
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669530051
—
ID
Enumeration date
11/22/2022
Last updated
11/22/2022
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