Organization
IDAHO SPORTS MEDICINE INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROY TWEEDLE (BUSINESS MANAGER)
(208) 336-8250
Entity
Organization
Contact information
Practice address
1188 W UNIVERSITY DR, BOISE, ID 83706-3009
(208) 336-8250
(208) 345-9514
Mailing address
1188 W UNIVERSITY DR, BOISE, ID 83706-3009
(208) 336-8250
(208) 345-9514
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
PT-1825
ID
Other
Enumeration date
01/10/2011
Last updated
01/10/2011
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