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1386349645
JACOB ADAM LOPEZ
BOISE, ID
NPI
1386349645
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225100000X Physical Therapist
Enumeration Date
2023-04-04
Last Update Date
2023-04-04
Business Address
JACOB ADAM LOPEZ
960 S BROADWAY AVE STE 200
BOISE, ID 83706-3667
Phone number: 208-433-9211
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Mailing Address
JACOB ADAM LOPEZ
16083 SW UPPER BOONES FERRY RD STE 300
TIGARD, OR 97224-7736
Phone number:
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