Provider Demographics
NPI:1982201661
Name:BRIGGS, JACE CHRISTIAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACE
Middle Name:CHRISTIAN
Last Name:BRIGGS
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 1:2450 E TERRY ST APT 4
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2743
Mailing Address - Country:US
Mailing Address - Phone:208-520-5375
Mailing Address - Fax:
Practice Address - Street 1:2640 CHANNING WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7517
Practice Address - Country:US
Practice Address - Phone:208-552-2248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-6717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist