Individual
MR. ROBERT W DRISCOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
64 S STAR RD UNIT 2, STAR, ID 83669-5497
(208) 488-4250
Mailing address
64 S STAR RD UNIT 2, STAR, ID 83669-5497
(208) 488-4250
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
PT18472
CA
225100000X
Physical Therapist
Primary
PT-7058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT18472
PHYSICAL THERAPY LICENSE
CA
Enumeration date
05/15/2007
Last updated
03/13/2023
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