Individual
M ANDREW MIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
276 EASTLAND DR N, TWIN FALLS, ID 83301-4458
(208) 735-8563
(208) 735-8564
Mailing address
276 EASTLAND DR N, TWIN FALLS, ID 83301-4458
(208) 735-8563
(208) 735-8564
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1352
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010141846
REGENCE
ID
05
—
806555000
—
ID
05
—
806571300
—
ID
01
—
P00045805
RAILROAD MEDICARE
ID
01
—
T7275
BLUE CROSS
ID
Enumeration date
04/18/2006
Last updated
11/24/2015
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