Idaho Physical Medicine & Rehabilitation
Physician Assistant in Boise, ID. Organization (NPI-2).
NPI number1497969604
StatusActive
Last updated in NPPESMar 16, 2010
Details
- NPI
- 1497969604
- Entity type
- Organization (NPI-2)
- Legal business name
- Idaho Physical Medicine & Rehabilitation
- Organization subpart
- Yes
- Enumeration date
- May 9, 2007
- Last updated
- Mar 16, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | – | – | Yes |
Other names
- PA Grp (Other Name)
Practice location
600 Robbins RdBoise, ID 83702-4539
Phone 208-489-4016 · Fax 208-489-4015
Mailing address
600 N. Robbins RdBoise, ID 83702
Phone 208-489-4016 · Fax 208-489-4015
Authorized official
Sharon A Lee
Administrator
2084895160
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