Individual
JONATHAN LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1310 W A ST, 102, MOSCOW, ID 83843-4035
(818) 331-5990
Mailing address
1310 W A ST, 102, MOSCOW, ID 83843-4035
(818) 331-5990
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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