Organization
BURLEY PHYSICAL THERAPY AND REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STACY GREENWELL (OFFICE MANAGER)
(208) 678-1191
Entity
Organization
Contact information
Practice address
1263 BENNETT AVE, SUITE 2, BURLEY, ID 83318-4906
(208) 678-1191
(208) 678-1214
Mailing address
1263 BENNETT AVE, SUITE 2, BURLEY, ID 83318-4906
(208) 678-1191
(208) 678-1214
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
—
ID
261QP2000X
Physical Therapy Clinic/Center
Primary
—
ID
261QX0100X
Occupational Medicine Clinic/Center
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026864
BLUE SHIELD
ID
01
—
T8604
BLUE CROSS
ID
Enumeration date
12/05/2006
Last updated
06/21/2018
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