TYLER JONATHON SMITH

BOISE, ID
NPI1770611261
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID  AT-261)
Enumeration Date2007-02-28
Last Update Date2007-07-08
Business Address
-- TYLER JONATHON SMITH LAT
2409 N CRIBBENS AVE
BOISE, ID 83713-5239
Phone number: 208-484-2047
Mailing Address
-- TYLER JONATHON SMITH LAT
1910 UNIVERSITY DR MS 1020
BOISE, ID 83725-0002
Phone number: 208-426-3944
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