Provider Demographics
NPI:1669812301
Name:FOSS, CALEB JEROME (DPT)
Entity Type:Individual
Prefix:
First Name:CALEB
Middle Name:JEROME
Last Name:FOSS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8382 N WAYNE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-6028
Mailing Address - Country:US
Mailing Address - Phone:208-758-0484
Mailing Address - Fax:208-485-4781
Practice Address - Street 1:8382 N WAYNE DR STE 100
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835
Practice Address - Country:US
Practice Address - Phone:208-758-0484
Practice Address - Fax:208-485-4781
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist