| Organization Name: | GRIDIRON REHAB AND ATHLETIC FITNESS |
| NPI Number: | 1033359450 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DENNIS S SILVEY (GROUP VP) |
| Mailing Address: | 3035 W Mcmillan Rd Suite 104 Meridian |
| State: | ID US |
| Postal Code: | 836466163 |
| Phone Number: | 2088878684 |
| Fax Number: | 2088879226 |
| NPI Enumeration Date: | 02/25/2009 |
| NPI Last Update Date: | 10/31/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |