Individual
MARK VINCENT I SORIANO MENDOZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
763 BOYD ST, CHUBBUCK, ID 83202-2941
(208) 417-9605
Mailing address
763 BOYD ST, CHUBBUCK, ID 83202-2941
(208) 417-9605
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3640
ID
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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