JACOB CASEBOLT

POCATELLO, ID
NPI1184162836
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2255A2300X Specialist/Technologist Athletic Trainer
(Licence: ID  AT-672)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2017-02-02
Last Update Date2019-07-12
Business Address
JACOB CASEBOLT AT
109 TAFT AVE
POCATELLO, ID 83201-5108
Phone number: 208-705-5038
Mailing Address
JACOB CASEBOLT AT
109 TAFT AVE
POCATELLO, ID 83201-5108
Phone number: 208-705-5038