Organization
EAGLE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, PLLC
Active
Organization
EAGLE ORTHOPEDIC & SPORTS PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE M. LUNDBERG PT (PHYSICAL THERAPIST/OWNER)
(208) 354-0089
Entity
Organization
Contact information
Practice address
600 VALLEY CENTRE DRIVE, DRIGGS, ID 83422
(208) 354-0089
(509) 561-0536
Mailing address
600 VALLEY CENTRE DRIVE, DRIGGS, ID 83422
(208) 354-0089
(509) 561-0536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805896600
—
ID
Enumeration date
03/19/2007
Last updated
03/06/2015
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