Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | ||
N | 2251S0007X | Physical Therapist - Sports | PT-3152 | ID |
N | 2251X0800X | Physical Therapist - Orthopedic | PT-3152 | ID |
NPI | 1053756882 |
---|---|
Provider Name | Joseph Jannuzzi |
First Address | Boise, ID 83709-2507 |
Second Address | Boise, ID 83709-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 24/07/2021 |