Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-1995 | ID |
NPI | 1003246778 |
---|---|
Provider Name | Melissa Pirtle |
First Address | Boise, ID 83702-5099 |
Second Address | Boise, ID 83702-5099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 18/11/2013 |