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Individual

JONATHAN DAC-MOANG LIEM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
1441 PARKWAY DR STE 1, BLACKFOOT, ID 83221-1667
(208) 785-3446
(208) 980-7241
Mailing address
1441 PARKWAY DR STE 1, BLACKFOOT, ID 83221-1667
(208) 785-3446
(208) 980-7241

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-8771
ID

Other

Enumeration date
11/09/2023
Last updated
11/09/2023
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