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Individual

JAMIE LYNN BENEDICT

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
128 5TH AVE W, JEROME, ID 83338-1863
(208) 324-3090
(208) 324-3093
Mailing address
239 TAYLOR ST W, KIMBERLY, ID 83341-1533
(208) 423-5633

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-400
ID

Other

Enumeration date
11/15/2005
Last updated
07/08/2007
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