Provider Demographics
NPI:1881486967
Name:ANSARI, HINA AIJAZ
Entity type:Individual
Prefix:
First Name:HINA
Middle Name:AIJAZ
Last Name:ANSARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 N TATTENHAM WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-2529
Mailing Address - Country:US
Mailing Address - Phone:208-939-3341
Mailing Address - Fax:208-939-3341
Practice Address - Street 1:1525 S ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2620
Practice Address - Country:US
Practice Address - Phone:208-939-0533
Practice Address - Fax:208-939-3341
Is Sole Proprietor?:No
Enumeration Date:2025-05-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9071665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist