Provider Demographics
NPI:1376811703
Name:MAGGIO, JOSEPH (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:MAGGIO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 N ROSARIO ST
Mailing Address - Street 2:STE 101
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-8095
Mailing Address - Country:US
Mailing Address - Phone:208-906-8322
Mailing Address - Fax:208-629-7059
Practice Address - Street 1:1097 N ROSARIO ST
Practice Address - Street 2:STE 101
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8095
Practice Address - Country:US
Practice Address - Phone:208-906-8322
Practice Address - Fax:208-629-7059
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID2707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist