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Search › Idaho › 1041S0200X

Matt Bannister

NPI 1457219842 · on the registry since 2026

Practice

Address
206 E Elm St
Caldwell, ID 83605
Phone
(208) 454-8389
Fax
(951) 264-6365
Organisation at this address
Progressive Therapy Pc
Human Supports Of Idaho
Inferred from a shared address, not stated in the registry.
Clinicians at this address
12

Registry record

Primary taxonomy
1041S0200X
1041S0200X
Licence states on file
ID
From the registry's licence fields, which are often incomplete.
Sex
Male
Record last updated
2026-01-13

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho