IndividualActive
Jeannie Mattox, PTA
NPI 1205503539 · Physical Therapy Assistant · Plummer, ID
Provider details
- NPI number
- 1205503539
- Entity type
- Individual
- Primary specialty
- Physical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Credential
- PTA
- Sex
- Female
- Sole proprietor
- No
- License
- PTA-6401 (ID)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Practice location
1100 a Street
Plummer, ID 83851
Phone: (208) 686-7041
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 516
Plummer, ID 83851-0516
Registry dates
- Enumerated
- 2021-08-25
- Last updated
- 2021-08-25
- Certified
- 2021-08-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.