Griffeth, Russell Gary
Griffeth, Russell Gary is an individual health care provider with primary practice located at 2037 E 17Th St , Idaho Falls ID 83404-6430. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Griffeth, Russell Gary can be contacted via phone (208) 529-3355.Contact Information
Primary practice address
2037 E 17Th St
Idaho Falls ID 83404-6430
Phone: (208) 529-3355
Fax: (208) 529-9581
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist | 225100000X | PT-623 | Idaho |
Profile Details
| NPI number | 1841359866 |
|---|---|
| LBN Legal business name | Griffeth, Russell Gary |
| Credentials | Master of Physical Therapy (MPT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 6th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1841359866 | NPPES |
| Idaho | Other | T1039 | BLUE CROSS |
| Idaho | Other | 000010021739 | BLUE CROSS |
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