Organization
PHYSICAL THERAPY SPORTS & REHAB
Active
Organization
PHYSICAL THERAPY SPORTS & REHAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLEN B MARTIN PPT (OWNER)
(208) 232-2740
Entity
Organization
Contact information
Practice address
540 S GARFIELD AVE, POCATELLO, ID 83204-3333
(208) 232-2740
Mailing address
540 S GARFIELD AVE, POCATELLO, ID 83204-3333
(208) 232-2740
(208) 232-7746
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT004
ID
225100000X
Physical Therapist
RPT195
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0026437
—
ID
Enumeration date
08/22/2005
Last updated
08/22/2020
Update your record
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