Organization
PROACTIVE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAULAN YOUNG MPT (PRESIDENT)
(208) 677-2489
Entity
Organization
Contact information
Practice address
2311 PARK AVE, SUITE 2, BURLEY, ID 83318-2170
(208) 677-2489
(208) 677-4023
Mailing address
2311 PARK AVE, SUITE 2, BURLEY, ID 83318-2170
(208) 677-2489
(208) 677-4023
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1299
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805407300
—
ID
Enumeration date
04/20/2007
Last updated
10/13/2010
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