Organization
IDAHO PHYSICAL MEDICINE & REHABILITATION
Active
Parent organization
IDAHO PHYSICAL MEDICINE & REHABILITATION
Other names
PA Grp
Organization subpart
Yes
Provider details
NPI number
Legal business name
IDAHO PHYSICAL MEDICINE & REHABILITATION
Authorized official
MS. SHARON A LEE (ADMINISTRATOR)
(208) 489-5160
Entity
Organization
Contact information
Practice address
600 ROBBINS RD, BOISE, ID 83702-4539
(208) 489-4016
(208) 489-4015
Mailing address
600 N. ROBBINS RD, BOISE, ID 83702
(208) 489-4016
(208) 489-4015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80746780
—
ID
Enumeration date
05/09/2007
Last updated
03/16/2010
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