JARED CLIVE SANSOM

BOISE, ID
NPI1790359594
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225200000X Physical Therapy Assistant
(Licence: ID  PTA-4725)
Enumeration Date2021-05-17
Last Update Date2021-05-17
Business Address
JARED CLIVE SANSOM PTA
3352 N KINGSWOOD WAY
BOISE, ID 83704-4385
Phone number: 208-421-5991
Mailing Address
JARED CLIVE SANSOM PTA
3352 N KINGSWOOD WAY
BOISE, ID 83704-4385
Phone number: 208-421-5991
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