Individual
BRYAN D HUNTSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S., P.T.
Contact information
Practice address
2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
(208) 529-8005
(208) 529-0251
Mailing address
2570 CHANNING WAY, IDAHO FALLS, ID 83404-7515
(208) 529-8005
(208) 529-0251
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT-457
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025914
BLUE SHIELD OF IDAHO ID#
ID
05
—
004401200
—
ID
01
—
82-0510764
TAX ID#
ID
01
—
T-144-3
BLUE CROSS OF IDAHO ID#
ID
Enumeration date
01/24/2007
Last updated
08/04/2010
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