Individual
TEVAGENE BRAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
203 S DAISY ST, SALMON, ID 83467-4709
(208) 756-5600
Mailing address
51 COUNTRY LIVING LN, SALMON, ID 83467-5372
(208) 681-9251
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
ID
Other
Enumeration date
04/07/2020
Last updated
04/07/2020
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