Provider Demographics
NPI:1639749534
Name:DRAKE REHABILITATION OUTCOMES PLLC
Entity Type:Organization
Organization Name:DRAKE REHABILITATION OUTCOMES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:208-761-3080
Mailing Address - Street 1:2656 S HARMONY AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5053
Mailing Address - Country:US
Mailing Address - Phone:208-761-3080
Mailing Address - Fax:
Practice Address - Street 1:3372 E JENALAN
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7787
Practice Address - Country:US
Practice Address - Phone:208-761-3080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty