Provider Demographics
NPI:1386862498
Name:WALD, DEBBIE (PT)
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:WALD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD
Mailing Address - Street 2:#204
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1338
Mailing Address - Country:US
Mailing Address - Phone:208-367-3315
Mailing Address - Fax:208-367-2674
Practice Address - Street 1:901 N CURTIS RD
Practice Address - Street 2:#204
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1338
Practice Address - Country:US
Practice Address - Phone:208-367-3315
Practice Address - Fax:208-367-2674
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist