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Organization

ATHLETIC TRAINING CENTER INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KERI HINE (VICE PRESIDENT)
(208) 870-9225
Entity
Organization

Contact information

Practice address
10259 W EMERALD ST, SUITE 160, BOISE, ID 83704-8987
(208) 658-0602
(208) 377-1468
Mailing address
PO BOX 147, CALDWELL, ID 83606-0147
(208) 455-1400
(208) 455-1449

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010155883
REGENCE BLUE SHIELD OF ID
ID
01
8M840
BLUE CROSS OF IDAHO
ID
Enumeration date
07/14/2006
Last updated
09/03/2008
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