Organization
HAILEY SPORT AND SPINE PHYSICAL THERAPY PA
Active
Organization
HAILEY SPORT AND SPINE PHYSICAL THERAPY PA
Active
Other names
HAILEY SPORT AND SPINE
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KIMBERLY A MAZIK PT (OWNER)
(208) 788-6312
Entity
Organization
Contact information
Practice address
810 S MAIN ST, STE 7A, HAILEY, ID 83333-8426
(208) 788-6312
(208) 578-1053
Mailing address
PO BOX 1693, 810 S MAIN ST STE 7A, HAILEY, ID 83333-1693
(208) 788-6312
(208) 578-1053
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1168
ID
Other
Enumeration date
10/08/2005
Last updated
08/22/2020
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