Individual
DR. COREY DUPONT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
910 E WASHINGTON ST, BOISE, ID 83712-7321
(208) 570-3004
Mailing address
910 E WASHINGTON ST, BOISE, ID 83712-7321
(208) 570-3004
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
6101
OR
225100000X
Physical Therapist
Primary
PT-2398
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639334279-000
—
ID
05
—
808487601
—
ID
01
—
P01610741
RR MEDICARE
ID
Enumeration date
07/23/2008
Last updated
02/06/2025
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