Provider Demographics
NPI:1972337426
Name:GRUBE, RILEY ALEN (DPT, PT)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:ALEN
Last Name:GRUBE
Suffix:
Gender:M
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-973-4144
Mailing Address - Fax:208-914-6563
Practice Address - Street 1:2194 SNAKE RIVER PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-4346
Practice Address - Country:US
Practice Address - Phone:208-973-4144
Practice Address - Fax:208-914-6563
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID8261274225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist