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Individual

DR. JARED DENOR LUNDQUIST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
2450 SKYLAR PL, POCATELLO, ID 83201
(435) 339-9058
Mailing address
2450 SKYLAR PL, POCATELLO, ID 83201-7708
(435) 339-9058

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
7940210-2401
UT
225100000X
Physical Therapist
Primary
PT-4454
ID

Other

Enumeration date
11/20/2013
Last updated
02/04/2019
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