Organization
POCATELLO PHYSICAL THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY C. SIDWELL PT (OWNER, PT)
(208) 232-6490
Entity
Organization
Contact information
Practice address
333 N 18TH AVE STE D2, POCATELLO, ID 83201-3358
(208) 232-6490
(208) 234-4805
Mailing address
333 N 18TH AVE STE D2, POCATELLO, ID 83201-3358
(208) 232-6490
(208) 234-4805
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
12/19/2019
Last updated
12/19/2019
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