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IDAHO FALLS PHYSICAL MEDICINE AND REHABILITATION

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Company Details

Name: IDAHO FALLS PHYSICAL MEDICINE AND REHABILITATION
Jurisdiction: Idaho
Legal type: Assumed Business Name
Status: Active-Current
Date of registration: 15 Aug 2011 (14 years ago)
Entity Number: 454844
Place of Formation: IDAHO
File Number: 0000454844
ZIP code: 83404
County: Bonneville County
Mailing Address: 2035 E 17TH ST IDAHO FALLS, ID 83404

National Provider Identifier

NPI Number:
1508086018

Authorized Person:

Name:
DR. DAVID C SIMON
Role:
PRESIDENT
Phone:

Taxonomy:

Selected Taxonomy:
208100000X - Physical Medicine & Rehabilitation Physician
Is Primary:
Yes

Contacts:

Fax:
2085354427

Filing

Filing Name Filing Number Filing date
Initial Filing 0000454844 2011-08-15

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Date of last update: 26 Sep 2024

Sources: Idaho Secretary of State