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ANTHONY BADEN POWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
527 MEMORIAL DR, POCATELLO, ID 83201-4063
(208) 478-3333
Mailing address
256 S JOHNSON AVE, POCATELLO, ID 83204-4228
(208) 419-8384

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA3510
ID

Other

Enumeration date
05/08/2019
Last updated
05/08/2019
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