Individual
MRS. ANDREA L LADOUCEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5255 OVERLAND RD, BOISE, ID 83705-2637
(208) 338-9486
(208) 338-9586
Mailing address
704 N GAIL PL, BOISE, ID 83706-2056
(218) 779-5570
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1984
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010153394
BLUE SHIELD
ID
01
—
TD389
BLUE CROSS
ID
Enumeration date
02/07/2006
Last updated
07/08/2007
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