Organization
ATHLETIC TRAINING CENTER INC.
Active
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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