Individual
PROF. RICKY KAREN LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC-R
Contact information
Practice address
727 NEZ PERCE DR, MOSCOW, ID 83843-4137
(208) 882-4368
Mailing address
727 NEZ PERCE DR, MOSCOW, ID 83843-4137
(208) 882-4368
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-157
ID
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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