Individual
DIRK ANDREASEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
32 W 1ST S, REXBURG, ID 83440-1810
(208) 359-0877
Mailing address
32 W 1ST S, REXBURG, ID 83440-1810
(208) 359-0877
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-737
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
327268
BLUE SHIELD PROVIDER #
ID
01
—
T3761
BLUE CROSS IDAHO PROVIDER
ID
Enumeration date
11/29/2006
Last updated
07/09/2007
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