Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT-1548 | ID |
NPI | 1356546865 |
---|---|
Provider Name | Mr. Douglas Winston Hoggatt |
First Address | Boise, ID 83709-5597 |
Second Address | Boise, ID 83704-0608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 08/07/2007 |