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1154665719
JEREMY HANSEN
BOISE, ID
NPI
1154665719
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
225200000X Physical Therapy Assistant
(Licence: ID PTA-341)
Enumeration Date
2012-11-20
Last Update Date
2012-11-20
Business Address
Mr. JEREMY HANSEN PTA
5959 N DISCOVERY WAY
BOISE, ID 83713-1556
Phone number: 208-378-0256
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Mailing Address
Mr. JEREMY HANSEN PTA
5959 N DISCOVERY WAY
BOISE, ID 83713-1556
Phone number: 208-378-0256
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