Organization
IDAHO PHYSICAL MEDICINE AND REHABILITATION PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY MECHAM (ADMINISTRATOR)
(208) 884-1333
Entity
Organization
Contact information
Practice address
3551 E. OVERLAND RD., MERIDIAN, ID 83642
(208) 884-1333
(208) 489-4015
Mailing address
PO BOX 1128, BOISE, ID 83701
(208) 884-1333
(208) 489-4015
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
ID
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
ID
Other
Enumeration date
04/20/2006
Last updated
01/15/2021
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