Provider Demographics
NPI:1881799369
Name:MUNNING, NICHOLAS A (RPT)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:MUNNING
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LILLIAN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-4301
Mailing Address - Country:US
Mailing Address - Phone:208-756-6734
Mailing Address - Fax:208-756-6734
Practice Address - Street 1:111 LILLIAN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-4301
Practice Address - Country:US
Practice Address - Phone:208-756-6734
Practice Address - Fax:208-756-6734
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID097225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1650964Medicare ID - Type Unspecified