| |
1460 E Shenandoah Dr, Boise, ID 83712-6657 | |
(208) 570-3004 | |
(208) 252-6297 |
Full Name | |
---|---|
Type | Facility |
Speciality | Clinic/center - Physical Therapy |
Location | 1460 E Shenandoah Dr, Boise, Idaho |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1861254278 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | (* (Not Available)) | Secondary |
261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Provider Name | Corey E Dupont |
---|---|
Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1639334279 PECOS PAC ID: 3577639392 Enrollment ID: I20080902000441 |
Mailing Address | Practice Location Address |
---|---|
1460 E Shenandoah Dr, Boise, ID 83712-6657 Ph: (208) 570-3004 | 1460 E Shenandoah Dr, Boise, ID 83712-6657 Ph: (208) 570-3004 |