Provider Demographics
NPI:1952379661
Name:GARVER, JAMI SUE (DPT,ATC,CSCS)
Entity Type:Individual
Prefix:MISS
First Name:JAMI
Middle Name:SUE
Last Name:GARVER
Suffix:
Gender:F
Credentials:DPT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W MYRTLE ST
Mailing Address - Street 2:STE 200
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6970
Mailing Address - Country:US
Mailing Address - Phone:208-489-4331
Mailing Address - Fax:208-489-4312
Practice Address - Street 1:1015 12TH AVE SO
Practice Address - Street 2:STE 105
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-467-4357
Practice Address - Fax:208-467-4395
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT2001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000010151990OtherBLUE SHIELD
TD066OtherBLUE CROSS
ID806804600Medicaid
136528Medicare ID - Type Unspecified