Doctor Name: | EMILY RENOVITCH |
NPI Number: | 1023396884 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PT |
License Number: | PT - 1742 |
Business Practice Address: | 600 Valley Centre Dr Driggs, ID - 834225095 |
Business Phone Number: | 2083540089 |
Business Fax Number: | |
Mailing Address: | 600 Valley Centre Drive, DRIGGS |
State: | ID |
Postal Code: | 83422 |
Phone Number: | 2083540089 |
Fax Number: | |
NPI Enumeration Date: | 07/28/2011 |
NPI Last Update Date: | 07/28/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251X0800X |
License Number: | PT - 1742 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Orthopedic |
Taxonomy Definition: |