Individual
RUSSELL GARY GRIFFETH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Mailing address
2037 E 17TH ST, IDAHO FALLS, ID 83404-6430
(208) 529-3355
(208) 529-9581
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-623
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010021739
BLUE SHIELD
—
01
—
T1039
BLUE CROSS
ID
Enumeration date
12/06/2006
Last updated
07/08/2007
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