Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT-2111 | ID |
NPI | 1154716322 |
---|---|
Provider Name | Casey Strunk |
First Address | Boise, ID 83702-4565 |
Second Address | Boise, ID 83702-4565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2015 |
Last Update Date | 03/04/2015 |