Provider Demographics
NPI:1790722932
Name:JONART, BRIAN M (MPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:JONART
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E PARKCENTER BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6751
Mailing Address - Country:US
Mailing Address - Phone:208-367-1010
Mailing Address - Fax:
Practice Address - Street 1:1175 E PARKCENTER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-6751
Practice Address - Country:US
Practice Address - Phone:208-367-1010
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-1947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist