Individual
GWEN SCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
12325 W CADDY CT, BOISE, ID 83709-6561
(208) 477-7373
Mailing address
12325 W CADDY CT, BOISE, ID 83709-6561
(208) 477-7373
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2114
ID
Other
Enumeration date
12/03/2012
Last updated
12/03/2012
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