Individual
PETE RICHAR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
131 N OAK ST, BLACKFOOT, ID 83221-1757
(208) 684-2444
Mailing address
131 N OAK ST, BLACKFOOT, ID 83221-1757
(208) 684-2444
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
8747
ID
Other
Enumeration date
05/08/2023
Last updated
05/08/2023
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