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Individual

TAIGAN NEIBAUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
901 N CURTIS RD STE 204, BOISE, ID 83706-1340
(208) 251-6426
Mailing address
6871 STAGE COACH RD, NAMPA, ID 83686-1282
(120) 825-1642

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5861
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0002138122
ID
Enumeration date
08/16/2018
Last updated
08/16/2018
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