| Organization Name: | PERIWINKLE CHILDREN'S THERAPY |
| NPI Number: | 1184972184 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTY ADAMS (CO-OWNER) |
| Mailing Address: | 1401 W Bizztown Loop Hayden |
| State: | ID US |
| Postal Code: | 838355113 |
| Phone Number: | 2087623502 |
| Fax Number: | 8883104824 |
| NPI Enumeration Date: | 08/22/2012 |
| NPI Last Update Date: | 08/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |