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Organization

PORGY AND PETUNIA PEDIATRIC THERAPY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GEORGENA YANOFF OTR (OWNER)
(484) 388-9729
Entity
Organization

Contact information

Practice address
7 RIGGAN LANE, SALMON, ID 83467-4301
(484) 388-9729
(484) 388-9729
Mailing address
516 MAIN ST, SALMON, ID 83467-4219
(484) 388-9729

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary

Other

Enumeration date
10/18/2017
Last updated
10/13/2023
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