Individual
MR. JEFFREY BOWEN DEMOND
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MPT, CLT
Contact information
Practice address
2321 E GALA ST, SUITE 1, MERIDIAN, ID 83642-4881
(208) 888-4321
(208) 895-8747
Mailing address
2654 N GOLDENEYE WAY, MERIDIAN, ID 83642-7803
(208) 887-1388
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1640
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154278
REGENCE BLUE SHIELD ID
ID
01
—
11571122
FIRST HEALTH CAQH
ID
01
—
TD264
BLUE CROSS OF IDAHO
ID
Enumeration date
06/22/2006
Last updated
07/09/2007
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