Individual
SAMUEL TIMOTHY HETHERINGTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
2005 12TH AVE RD, NAMPA, ID 83686-6311
(208) 463-0022
(208) 463-0031
Mailing address
2005 12TH AVE RD, NAMPA, ID 83686-6311
(208) 463-0022
(208) 463-0031
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6926
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-6926
STATE LICENSE
ID
Enumeration date
08/05/2020
Last updated
08/05/2020
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