Individual
LISA MARIE ROPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S, ATC, LAT
Contact information
Practice address
1900 W PINE AVE, MERIDIAN, ID 83642-1961
(208) 350-4160
(208) 350-4178
Mailing address
4075 N TALLGRASS AVE, MERIDIAN, ID 83646-2613
(208) 936-5445
Taxonomy
Speciality
Code
Description
License number
State
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
AT-374
ID
2255A2300X
Athletic Trainer
AT-AT-148663
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063455608
AT-374
OR
Enumeration date
06/13/2006
Last updated
12/03/2016
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