Individual
EMMA STAYDUHAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
(208) 784-4603
Mailing address
25 JACOBS GULCH RD, KELLOGG, ID 83837-2023
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT3839
ID
Other
Enumeration date
08/28/2018
Last updated
08/28/2018
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