Organization
CENTER FOR ORTHOPEDIC REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN T BATES MPT (PRESIDENT)
(208) 232-4267
Entity
Organization
Contact information
Practice address
275 S 5TH AVE STE 140, POCATELLO, ID 83201-6410
(208) 232-4267
(208) 232-4268
Mailing address
275 S 5TH AVE STE 140, POCATELLO, ID 83201-6410
(208) 232-4267
(208) 232-4268
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1730
ID
225100000X
Physical Therapist
PT-2487
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806506300
—
ID
Enumeration date
01/08/2007
Last updated
12/09/2009
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