Organization
ALLSTAR PHYSICAL THERAPY, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNN R JOHNSON (OWNER)
(208) 571-6739
Entity
Organization
Contact information
Practice address
4809 W FAIRVIEW AVE, BOISE, ID 83706-2242
(208) 321-4535
Mailing address
1552 SANCTUARY LANE, HOMEDALE, ID 83628
(208) 337-5346
(208) 337-5346
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT178
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025680
REGENCE BLUE SHIELD
ID
01
—
T4884
BLUE CROSS
ID
Enumeration date
12/13/2006
Last updated
08/22/2020
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