Individual
MRS. CRISTA ANN JARDINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2499 FIELDSTONE DR, AMMON, ID 83401-5854
(208) 681-6677
(208) 209-8574
Mailing address
2499 FIELDSTONE DR, AMMON, ID 83401-5854
(208) 681-6677
(208) 209-8574
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
PTA-110
ID
Other
Enumeration date
03/29/2013
Last updated
03/29/2013
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