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Individual

DIANE GOODMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
520 S EAGLE RD STE 2106, MERIDIAN, ID 83642-6363
(208) 706-5775
(208) 706-5777
Mailing address
3732 S DAISY WAY, BOISE, ID 83709-3762

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1736
ID

Other

Enumeration date
11/22/2013
Last updated
11/22/2013
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