Custom Rehab LLC

NPI #1215204862 in Chubbuck, Idaho

Provider Information

NPI Number: 1215204862
Entity Type: Organization
Organization Name: Custom Rehab LLC
Primary Specialty: Physical Therapist
Enumeration Date: Nov 28, 2011
Last Updated: Nov 30, 2011

Practice Location

Address: 265 E CHUBBUCK RD
City: Chubbuck
State: Idaho
ZIP Code: 83202-5055
Phone: (208) 244-1882

Authorized Official

Name: JARED L MCKEE, PT
Title: OWNER
Phone: (208) 244-1882

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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