Organization
PHYSICAL THERAPY AND SPORTS MEDICINE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA B JENKINS (SECRETARY)
(208) 745-8580
Entity
Organization
Contact information
Practice address
4102 E 82 N, RIGBY, ID 83442-5894
(208) 745-8580
(208) 745-8580
Mailing address
4102 E 82 N, RIGBY, ID 83442-5894
(208) 745-8580
(208) 745-8580
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
T 236
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002591700
—
ID
05
—
806469200
—
ID
Enumeration date
12/12/2007
Last updated
09/15/2008
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