Basic Information
| Provider Information | |||||||||
| NPI: | 1124630686 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALSNES | ||||||||
| FirstName: | JORID | ||||||||
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| Credential: | DPT, PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 788 TONYA RD | ||||||||
| Address2: | |||||||||
| City: | VICTOR | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834554829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707345229 | ||||||||
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| Practice Location | |||||||||
| Address1: | 180 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DRIGGS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 834225034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083543128 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2020 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-6998 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.