Individual
CARISSA KANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAT, ATC
Contact information
Practice address
1010 W WASHINGTON ST, BOISE, ID 83702-5446
(208) 794-4644
Mailing address
1010 W WASHINGTON ST, BOISE, ID 83702-5446
(208) 794-4644
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-289
ID
Other
Enumeration date
03/22/2014
Last updated
03/22/2014
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