Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 6248 | ID |
NPI | 1003477274 |
---|---|
Provider Name | Bridget Gilbertson |
First Address | Boise, ID 83702-6754 |
Second Address | Boise, ID 83702-6754 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2019 |
Last Update Date | 27/06/2019 |