Teton Outpatient, LLC
NPI #1518242395 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1518242395
- Entity Type
- Organization
- Organization Name
- Teton Outpatient, LLC
- Primary Specialty
- Clinic/Center - Rehabilitation
- Enumeration Date
- Oct 12, 2011
- Last Updated
- Oct 12, 2011
Practice Location
- Address
- 403 1ST ST
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83401-3928
- Phone
- (208) 419-0896
Authorized Official
- Name
- MR. JACOB RAYMOND BRYAN, MOT
- Title
- OWNER
- Phone
- (208) 419-0896
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Rehabilitation — Rehabilitation |
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