Provider Demographics
NPI:1235458654
Name:TREASURE VALLEY REHABILITATION
Entity Type:Organization
Organization Name:TREASURE VALLEY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:S
Authorized Official - Last Name:RICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, DPT
Authorized Official - Phone:208-695-6688
Mailing Address - Street 1:524 E CLEVELAND BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605
Mailing Address - Country:US
Mailing Address - Phone:208-695-6688
Mailing Address - Fax:
Practice Address - Street 1:524 CLEVELAND BLVD STE 110
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-4079
Practice Address - Country:US
Practice Address - Phone:208-695-6688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-21722251X0800X
IDOT-810225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty