| NPI | 1366436313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARITY KRISTIN BERRIER Owner 208-866-6549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ID AT-255) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: ID AT-255) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2017-04-06 |