Provider Demographics
NPI:1689349300
Name:J GORRICETA PLLC
Entity Type:Organization
Organization Name:J GORRICETA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORRICETTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-534-8330
Mailing Address - Street 1:1448 E CENTER ST STE D
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4132
Mailing Address - Country:US
Mailing Address - Phone:208-534-8330
Mailing Address - Fax:208-218-8161
Practice Address - Street 1:1448 E CENTER ST STE D
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4132
Practice Address - Country:US
Practice Address - Phone:208-534-8330
Practice Address - Fax:208-218-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy