Individual
MRS. LADEAN I PACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1501 HILAND AVE, BURLEY, ID 83318-2682
(208) 678-4444
(208) 677-6306
Mailing address
3465 E 1557 S, MALTA, ID 83342-7700
(208) 645-2622
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-160
ID
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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