Organization
FAMILY PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID B LITTLE P.T. (OWNER / PHYSICAL THERAPIST)
(208) 733-3900
Entity
Organization
Contact information
Practice address
834 FALLS AVE STE 1250, TWIN FALLS, ID 83301-3364
(208) 733-3900
(208) 733-3908
Mailing address
834 FALLS AVE STE 1250, TWIN FALLS, ID 83301-3364
(208) 733-3900
(208) 733-3908
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT357
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026870
REGNECE BLUE SHIELD OF ID
ID
01
—
1375725
MEDICARE GROUP
ID
01
—
T9115
BLUE CROSS OF IDAHO
ID
Enumeration date
07/10/2007
Last updated
07/10/2007
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