Graduated: 2014
NPI: 1912225335
Practice Locations (2)
CUSTOM REHAB LLC
265 E CHUBBUCK RD A
CHUBBUCK, ID 832015055
2084170011
PHYSICAL THERAPY SPECIALISTS OF IDAHO
675 YELLOWSTONE AVE, SUITE 1
POCATELLO, ID 832014511
2084781488
Source: CMS National Downloadable File, September 2026.