Individual
TARA MARIE LODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
601 W CAMERON AVE, KELLOGG, ID 83837-2004
(208) 784-1625
Mailing address
203 SILVER SADDLE CT, PINEHURST, ID 83850-0002
(208) 240-3328
(208) 784-1692
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2709
ID
Other
Enumeration date
08/09/2018
Last updated
08/09/2018
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