Provider Demographics
NPI:1518175686
Name:VINING, ROBERT GRAY III (MPT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GRAY
Last Name:VINING
Suffix:III
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:2176 E FRANKLIN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9024
Mailing Address - Country:US
Mailing Address - Phone:208-288-1155
Mailing Address - Fax:208-288-0424
Practice Address - Street 1:943 N LINDER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3394
Practice Address - Country:US
Practice Address - Phone:208-922-1719
Practice Address - Fax:208-322-8710
Is Sole Proprietor?:No
Enumeration Date:2007-05-20
Last Update Date:2011-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX11587292251X0800X
IDPT-28062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic