Individual
JESSICA ANNELAINE VANDYKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
282 W BRIDGE ST, BLACKFOOT, ID 83221
(208) 684-0021
Mailing address
1800 FLANDRO DR STE 190, POCATELLO, ID 83202-4940
(208) 233-2248
(208) 233-0219
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5957
ID
Other
Enumeration date
11/02/2018
Last updated
09/16/2022
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