Basic Information
| Provider Information | |||||||||
| NPI: | 1497797054 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MURRI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7550 W EMERALD ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083750666 | ||||||||
| FaxNumber: | 2083752996 | ||||||||
| Practice Location | |||||||||
| Address1: | 533 S MIDDLETON RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETON | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836446014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2085856566 | ||||||||
| FaxNumber: | 2085856768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-1954 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000010150569 | 01 | ID | BLUE SHIELD OF IDAHO | OTHER | 2554496 | 01 | ID | UNITED HEALTHCARE | OTHER | TC266 | 01 | ID | BLUE CROSS OF IDAHO | OTHER |