Organization
CUSTOM REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JARED L MCKEE PT (OWNER)
(208) 244-1882
Entity
Organization
Contact information
Practice address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 244-1882
Mailing address
857 SHEBA RD, CHUBBUCK, ID 83202-2522
(208) 244-1882
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
11/28/2011
Last updated
11/30/2011
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