Individual
JEANNIE MARIE MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1100 A STREET, PLUMMER, ID 83851
(208) 686-7041
Mailing address
PO BOX 516, PLUMMER, ID 83851-0516
(208) 686-7041
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-6401
ID
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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