Organization
PERIWINKLE CHILDREN'S THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY ADAMS (CO-OWNER)
(208) 762-3502
Entity
Organization
Contact information
Practice address
1401 W BIZZTOWN LOOP, HAYDEN, ID 83835-5113
(208) 762-3502
(888) 310-4824
Mailing address
1401 W BIZZTOWN LOOP, HAYDEN, ID 83835-5113
(208) 762-3502
(888) 310-4824
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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