Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1475 | ID |
NPI | 1003205949 |
---|---|
Provider Name | Robbin Warner |
First Address | Boise, ID 83712-6241 |
Second Address | Ketchum, ID 83340 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 15/01/2015 |