Provider Demographics
NPI:1477336105
Name:CAROLYN BLOCK PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:CAROLYN BLOCK PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:208-559-6979
Mailing Address - Street 1:1015 W HAYS ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5412
Mailing Address - Country:US
Mailing Address - Phone:208-617-3560
Mailing Address - Fax:
Practice Address - Street 1:1015 W HAYS ST STE 210
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5412
Practice Address - Country:US
Practice Address - Phone:208-617-3560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty