Organization
LON M. EGBERT, P.C.
Active
Other names
Jerome Physical Therapy & Sports Medicine Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LON M EGBERT PT, ATC (PRESIDENT OWNER)
(208) 324-3090
Entity
Organization
Contact information
Practice address
128 5TH AVE WEST, JEROME, ID 83338
(208) 324-3090
(208) 324-3093
Mailing address
PO BOX 565, JEROME, ID 83338
(208) 324-3090
(208) 324-3093
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1686
ID
2255A2300X
Athletic Trainer
PENDING
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
ID
Enumeration date
10/03/2006
Last updated
01/15/2010
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