Organization
IDAHO LUNG AND HEART
Active
Organization
IDAHO LUNG AND HEART
Active
Other names
Idaho Lung and Heart
Organization subpart
No
Provider details
NPI number
Authorized official
BRADLEY S CORDERO (OWNER)
(208) 359-9570
Entity
Organization
Contact information
Practice address
38 S 2ND E, REXBURG, ID 83440-2671
(801) 616-7253
Mailing address
38 S 2ND E STE 2, REXBURG, ID 83440-2675
(801) 616-7253
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
01/26/2024
Last updated
02/04/2025
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