Basic Information
| Provider Information | |||||||||
| NPI: | 1740669365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIVING OAK INTEGRATED MEDICINE AND REHABILITATION PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3372 E JENALAN | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838547787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248889428 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Practice Location | |||||||||
| Address1: | 3372 E JENALAN | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838547787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248889428 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2015 | ||||||||
| LastUpdateDate: | 05/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | FERRELL | ||||||||
| AuthorizedOfficialFirstName: | TIMMY | ||||||||
| AuthorizedOfficialMiddleName: | ALLAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7248889428 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | M-12915 | ID | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.