Organization
CHANNING PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MEISHA ADAMS (BILLING MANAGER)
(208) 529-8005
Entity
Organization
Contact information
Practice address
2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
(208) 529-8005
Mailing address
2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
(208) 529-8005
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
39012
BS OF IDAHO GROUP ID#
ID
05
—
805633700
—
ID
01
—
T-097-3
BC OF IDAHO GROUP ID#
ID
Enumeration date
04/22/2007
Last updated
06/21/2018
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