Provider Demographics
NPI:1578859054
Name:DEVOE, CARA (DPT)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:DEVOE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 HAWTHORNE RD STE 3B
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-2376
Mailing Address - Country:US
Mailing Address - Phone:208-237-9833
Mailing Address - Fax:208-237-1800
Practice Address - Street 1:4650 HAWTHORNE RD STE 3B
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-2376
Practice Address - Country:US
Practice Address - Phone:208-237-9833
Practice Address - Fax:208-237-1800
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist