Provider Demographics
NPI:1912639618
Name:HILL, ANNETTE RENEE (MPT)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:RENEE
Last Name:HILL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:RENEE
Other - Last Name:MCCUBBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:720 S WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-5285
Mailing Address - Country:US
Mailing Address - Phone:208-552-5025
Mailing Address - Fax:
Practice Address - Street 1:720 S WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-5285
Practice Address - Country:US
Practice Address - Phone:208-552-5025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist