Provider Demographics
NPI:1497321509
Name:INVICTUS RX PLLC
Entity Type:Organization
Organization Name:INVICTUS RX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-360-9151
Mailing Address - Street 1:2085 ALAN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5792
Mailing Address - Country:US
Mailing Address - Phone:208-360-9151
Mailing Address - Fax:
Practice Address - Street 1:847 LINDSAY BLVD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-1819
Practice Address - Country:US
Practice Address - Phone:208-504-1895
Practice Address - Fax:208-646-4279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty