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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