Organization
MAYES PHYSICAL THERAPY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DARYL DEAN MAYES P.T., D.P.T., M.H.S. (OWNER)
(208) 644-1433
Entity
Organization
Contact information
Practice address
1976 S LINCOLN AVE, SUITE 6A, JEROME, ID 83338-6150
(208) 644-1433
(208) 644-1434
Mailing address
1976 S LINCOLN AVE, SUITE 6A, JEROME, ID 83338-6150
(208) 644-1433
(208) 644-1434
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
125
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010023964
REGENCE BLUE SHIELD PIN
ID
05
—
0044033
—
ID
01
—
1002857
STATE INSURANCE ID
ID
01
—
1033262183
INDIVIDUAL NPI
ID
01
—
125
STATE ID LICENSE
ID
01
—
390146
REGENCE BLUE SHIELD ID
ID
01
—
T2797
BLUE CROSS ID
ID
Enumeration date
06/27/2007
Last updated
05/28/2013
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