Organization
PRESTON PHYSICAL THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES R ACEVEDO PT (MEMBER)
(208) 852-1143
Entity
Organization
Contact information
Practice address
10 S 100 W STE A, PRESTON, ID 83263-1244
(208) 852-1143
(208) 852-3951
Mailing address
PO BOX 14, LEWISTON, UT 84320-0014
(435) 770-5199
(208) 852-3951
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
10/08/2009
Last updated
12/02/2009
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