Organization
PHYSICAL THERAPY 180 LLC
Active
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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