1841545696 NPI number — CALEB LOUVIER PT

Table of content: CALEB LOUVIER PT (NPI 1841545696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841545696 NPI number — CALEB LOUVIER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOUVIER
Provider First Name:
CALEB
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841545696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 E PARKCENTER BLVD STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83706-6752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-344-2525
Provider Business Mailing Address Fax Number:
208-344-3056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 E PARKCENTER BLVD STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706-6752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-344-2525
Provider Business Practice Location Address Fax Number:
208-344-3056
Provider Enumeration Date:
07/18/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT60286845 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT-7533 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)