Provider Demographics
NPI:1669925970
Name:CHOQUETTE, CLINTON
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:CHOQUETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 6TH ST N STE 102
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5016
Mailing Address - Country:US
Mailing Address - Phone:406-560-1048
Mailing Address - Fax:
Practice Address - Street 1:8 6TH ST N STE 102
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5016
Practice Address - Country:US
Practice Address - Phone:406-560-1048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PT-LIC-11118225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist