Individual
JASON DETWILER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2411 S ESSEX WAY, BOISE, ID 83709-2304
(208) 353-0976
Mailing address
2411 S ESSEX WAY, BOISE, ID 83709-2304
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
40QB00360700
NJ
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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