Provider Demographics
NPI:1366102063
Name:VALLEY REHAB OF IDAHO INC
Entity type:Organization
Organization Name:VALLEY REHAB OF IDAHO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEVILBISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-209-0235
Mailing Address - Street 1:582 E BOISE AVE # 1011
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-5116
Mailing Address - Country:US
Mailing Address - Phone:916-209-0235
Mailing Address - Fax:
Practice Address - Street 1:582 E BOISE AVE # 1011
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-5116
Practice Address - Country:US
Practice Address - Phone:916-209-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty