Provider Demographics
NPI:1679199921
Name:CHAMPLIN, SETH ROBERT (DPT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:ROBERT
Last Name:CHAMPLIN
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 1:3850 N 3300 E
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5051
Mailing Address - Country:US
Mailing Address - Phone:208-539-2350
Mailing Address - Fax:
Practice Address - Street 1:3035 W MCMILLAN RD STE 104
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6292
Practice Address - Country:US
Practice Address - Phone:208-887-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6711225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist