Idaho Pediatric Therapy Clinic Pllc

NPI #1194125617 in Meridian, Idaho

Provider Information

NPI Number: 1194125617
Entity Type: Organization
Organization Name: Idaho Pediatric Therapy Clinic Pllc
Primary Specialty: Physical Therapist
Enumeration Date: Sep 3, 2014
Last Updated: Jul 9, 2019

Practice Location

Address: 3080 E GENTRY WAY STE 180
City: Meridian
State: Idaho
ZIP Code: 83642-3544
Phone: (208) 939-3334

Authorized Official

Name: JENNIFER LONGORIA
Title: OFFICE MANAGER
Phone: (208) 939-3334

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Occupational Therapist	225X00000X
Speech-Language Pathologist	235Z00000X
Physical Therapist	225100000X	Primary

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