Provider Demographics
NPI:1154467629
Name:JUE, CHRISTINE (MPT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:JUE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 ANDERSON ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-0840
Mailing Address - Country:US
Mailing Address - Phone:208-287-0993
Mailing Address - Fax:208-287-0996
Practice Address - Street 1:413 ALLUMBAUGH ST
Practice Address - Street 2:STE 102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-287-0993
Practice Address - Fax:208-287-0996
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT1244225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010150283OtherREGENCE BLUE SHIELD OF ID
IDTA500OtherBLUE CROSS OF IDAHO
1655666Medicare ID - Type Unspecified