DEIDRA NICHOLS

SHELLEY, ID
NPI1225390305
Former NameDEIDRA RAQUEL GOSHERT
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: ID  PT3043)
Enumeration Date2012-06-13
Last Update Date2019-12-31
Business Address
DEIDRA NICHOLS DPT
650 N STATE ST
SHELLEY, ID 83274-4900
Phone number: 208-782-4744
Mailing Address
DEIDRA NICHOLS DPT
650 N STATE ST
SHELLEY, ID 83274-4900
Phone number: 208-782-4744
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