Basic Information
| Provider Information | |||||||||
| NPI: | 1558350587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHILES | ||||||||
| FirstName: | JAMI | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9652 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | STAR | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836695858 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082860766 | ||||||||
| FaxNumber: | 2082860768 | ||||||||
| Practice Location | |||||||||
| Address1: | 4400 E FLAMINGO AVE | ||||||||
| Address2: | |||||||||
| City: | NAMPA | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836879203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082884970 | ||||||||
| FaxNumber: | 2084633044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 03/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1206 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 807197100 | 05 | ID | MEDICAID | PC332 | 01 | ID | BLUE CROSS | OTHER | 000010150364 | 01 | ID | BLUE SHIELD | OTHER |