Provider Demographics
NPI:1972666139
Name:GIRTON, JEFFREY ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ROBERT
Last Name:GIRTON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6430
Mailing Address - Country:US
Mailing Address - Phone:208-529-3355
Mailing Address - Fax:208-529-9581
Practice Address - Street 1:167 E 1ST STREET
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442
Practice Address - Country:US
Practice Address - Phone:208-745-8747
Practice Address - Fax:208-529-9581
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010021739OtherBLUE SHIELD
IDT7283OtherBLUE CROSS
ID000010021739OtherBLUE SHIELD