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Individual

ROCKY WADE ELSASSER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
943 N LINDER RD, SUITE 104, KUNA, ID 63634-3395
(208) 922-1719
(208) 922-1721
Mailing address
2176 E FRANKLIN RD, SUITE 100, MERIDIAN, ID 83642-9024
(208) 288-1155
(208) 288-0424

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
49332238-2401
UT
225100000X
Physical Therapist
Primary
PT-2180
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807785000
ID
Enumeration date
07/09/2006
Last updated
12/17/2009
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