Periwinkle Children's Therapy

NPI #1184972184 in Hayden, Idaho

Provider Information

NPI Number: 1184972184
Entity Type: Organization
Organization Name: Periwinkle Children's Therapy
Primary Specialty: Contractor
Enumeration Date: Aug 22, 2012
Last Updated: Aug 22, 2012

Practice Location

Address: 1401 W BIZZTOWN LOOP
City: Hayden
State: Idaho
ZIP Code: 83835-5113
Phone: (208) 762-3502

Authorized Official

Name: CHRISTY ADAMS
Title: CO-OWNER
Phone: (208) 762-3502

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist - Pediatrics — Pediatrics	2251P0200X
Occupational Therapist - Pediatrics — Pediatrics	225XP0200X
Contractor	171W00000X	Primary

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