Individual
MRS. TIFANI WAECHTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
43 NORTH 100 EAST, PRESTON, ID 83263
(208) 852-0116
(208) 852-0116
Mailing address
3445 WEST 2000 NORTH, DAYTON, ID 83232
(208) 747-3418
(208) 852-0116
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-1129
ID
Other
Enumeration date
10/02/2006
Last updated
07/08/2007
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