Organization
PHYSICAL THERAPY 180 LLC
Active
Other names
Physical Therapy 180
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CORY ALLEN MCKNIGHT (OWNER)
(208) 343-7700
Entity
Organization
Contact information
Practice address
5909 W STATE STREET, BOISE, ID 83703
(208) 343-7700
(208) 331-2591
Mailing address
5909 W STATE STREET, BOISE, ID 83703
(208) 343-7700
(208) 331-2591
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808631800
—
ID
Enumeration date
04/11/2007
Last updated
01/17/2019
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