LOGAN ELLIS

BOISE, ID
NPI1568900769
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID  AT-641)
Enumeration Date2017-02-08
Last Update Date2018-03-17
Business Address
LOGAN ELLIS
703 S AMERICANA BLVD STE 120
BOISE, ID 83702-6754
Phone number: 208-489-5543
Mailing Address
LOGAN ELLIS
9630 W LEO CT
BOISE, ID 83709-8250
Phone number:
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