Individual
MR. NICHOLAS P GREENWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1263 BENNETT AVE, SUITE 2, BURLEY, ID 83318-2666
(208) 678-1191
(208) 678-1214
Mailing address
1263 BENNETT AVE, STE 2, BURLEY, ID 83318-4906
(208) 678-1191
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1359
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010009167
BLUE SHIELD
ID
05
—
805407400
—
ID
01
—
T5311
BLUE CROSS
ID
Enumeration date
12/05/2006
Last updated
02/10/2016
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