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Organization

HAILEY PHYSCIAL THERAPY, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY HOGAN PT (OWNER/ PHYSICAL THERAPIST)
(208) 481-0275
Entity
Organization

Contact information

Practice address
21 EAST MAPLE STREET, SUITE D, HAILEY, ID 83333
(208) 481-0275
(208) 578-7757
Mailing address
PO BOX 3113, HAILEY, ID 83333-3113
(208) 481-0275
(208) 578-7757

Taxonomy

Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
651
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
807318900
ID
Enumeration date
08/26/2006
Last updated
10/04/2011
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