Individual
MR. JEREMY HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5959 N DISCOVERY WAY, BOISE, ID 83713-1556
(208) 378-0256
(208) 378-0269
Mailing address
5959 N DISCOVERY WAY, BOISE, ID 83713-1556
(208) 378-0256
(208) 378-0269
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-341
ID
Other
Enumeration date
11/20/2012
Last updated
11/20/2012
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