Individual
MRS. SAMANTHA PATRICIA BOURASSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
2832 E POLELINE AVE, POST FALLS, ID 83854
(208) 773-0581
Mailing address
1852 DIPPER LOOP, POST FALLS, ID 83854-5647
(406) 899-3757
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-436
ID
Other
Enumeration date
04/02/2019
Last updated
04/02/2019
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