Organization
NORTHRUP PHYSICAL THERAPY, PC
Active
Organization
NORTHRUP PHYSICAL THERAPY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK NORTHRUP P.T. (OWNER PRESIDENT)
(208) 221-6952
Entity
Organization
Contact information
Practice address
4473 FOX CT, CHUBBUCK, ID 83202-2670
(208) 221-6952
(208) 236-6695
Mailing address
4473 FOX CT, CHUBBUCK, ID 83202-2670
(208) 221-6952
(208) 236-6695
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1280
ID
Other
Enumeration date
12/04/2006
Last updated
07/12/2007
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