LON MIGUEL EGBERT

JEROME, ID
NPI1437130952
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: ID  PT1686)
Enumeration Date2005-11-10
Last Update Date2007-07-08
Business Address
-- LON MIGUEL EGBERT PT, ATC
128 5TH AVE W
JEROME, ID 83338-1863
Phone number: 208-324-3090
Mailing Address
-- LON MIGUEL EGBERT PT, ATC
3121 EAGLE RIDGE DR
WENDELL, ID 83355-3340
Phone number: 208-536-2135