Provider Demographics
NPI:1205307485
Name:SCOLIOSIS TREATMENT CENTER OF IDAHO
Entity type:Organization
Organization Name:SCOLIOSIS TREATMENT CENTER OF IDAHO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-908-8540
Mailing Address - Street 1:2157 S PEBBLECREEK LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6123
Mailing Address - Country:US
Mailing Address - Phone:208-908-8540
Mailing Address - Fax:
Practice Address - Street 1:2157 S PEBBLECREEK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6123
Practice Address - Country:US
Practice Address - Phone:208-908-8540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty