Most Relevant Information
Provider Data
| NPI Number: | 1003471665 |
| Provider Name: | ANTHONY BADEN POWELL PTA |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | PTA3510 |
Most Important Dates
| Enumeration Date: | 05/08/2019 |
| Last Updated: | 05/08/2019 |
Provider Practice Location
527 MEMORIAL DR
POCATELLO
ID
832014063
Practice Location Phone/Fax
| Phone: | 2084783333 |
| Fax: |
Provider Mailing Location
256 S JOHNSON AVE
POCATELLO
ID
832044228
Provider Mailing Phone/Fax
| Phone: | 2084198384 |
| Fax: |