Organization
ADVANCED PERFORMANCE PHYSICAL THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LANCE MARSHALL PT, DPT, MS (OWNER)
(208) 232-6490
Entity
Organization
Contact information
Practice address
333 N 18TH AVE, STE D-2, POCATELLO, ID 83201-3358
(208) 232-6490
(208) 234-4805
Mailing address
333 N 18TH AVE, STE D-2, POCATELLO, ID 83201-3358
(208) 232-6490
(208) 234-4805
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT1003
ID
225100000X
Physical Therapist
Primary
PT1535
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805858600
—
ID
Enumeration date
07/27/2006
Last updated
01/30/2017
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