| Organization Name: | IDAHO PEDIATRIC THERAPY CLINIC PLLC |
| NPI Number: | 1194125617 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT ADAMS (MANAGER) |
| Mailing Address: | 13895 W Wainwright Dr Boise |
| State: | ID US |
| Postal Code: | 837135011 |
| Phone Number: | 2089393334 |
| Fax Number: | 2089393341 |
| NPI Enumeration Date: | 09/03/2014 |
| NPI Last Update Date: | 01/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-1450 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |