Provider Demographics
NPI:1407662729
Name:RAM REHAB
Entity type:Organization
Organization Name:RAM REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KORELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:208-546-2808
Mailing Address - Street 1:33 N PHILLIPPI ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 N PHILLIPPI ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1417
Practice Address - Country:US
Practice Address - Phone:208-546-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty