Individual
LINDSEY E. DECLOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.P.T.
Contact information
Practice address
9652 W STATE ST, STAR, ID 83669-5858
(208) 286-0766
Mailing address
801 E SAN PEDRO ST, MERIDIAN, ID 83646-5650
(208) 991-8608
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2387
ID
Other
Enumeration date
09/20/2006
Last updated
01/07/2015
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