Individual
MR. TRENT JACKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
GARRISON BLDG 63, ROOM 202, STOP 8045, POCATELLO, ID 83209-0001
(208) 282-3065
Mailing address
DEPT OF PHYSICAL THERAPY IDAHO STATE UNIVERSITY, STOP 8045, POCATELLO, ID 83209-0001
(208) 282-3065
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
PT-1236
ID
Other
Enumeration date
08/13/2007
Last updated
08/13/2007
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