Organization
PEDIATRIC DEVELOPMENT CLINIC
Active
Other names
PDC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES A KING MS, OTR/L (PRESIDENT)
(208) 339-7234
Entity
Organization
Contact information
Practice address
4846 WIND RIVER RD, IDAHO FALLS, ID 83401-5828
(208) 339-7234
(208) 552-0935
Mailing address
PO BOX 365, IONA, ID 83427-0365
(208) 339-7234
(208) 552-0395
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
ID
Other
Enumeration date
10/28/2014
Last updated
10/28/2014
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