Provider Demographics
NPI:1740335215
Name:MURPHY, BRIAN (MPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:MURPHY
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 1:2085 E HOSPITALITY LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-6603
Mailing Address - Country:US
Mailing Address - Phone:208-367-1010
Mailing Address - Fax:208-367-1011
Practice Address - Street 1:2085 E HOSPITALITY LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-6603
Practice Address - Country:US
Practice Address - Phone:208-367-1010
Practice Address - Fax:208-367-1011
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1704225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806591400Medicaid
ID806591400Medicaid