Individual
JESSE SAMPOGNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
9508 W FAIRVIEW AVE, BOISE, ID 83704-8103
(208) 323-1313
Mailing address
6023 S KELSO WAY, BOISE, ID 83709-4055
(208) 789-7763
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6709
ID
Other
Enumeration date
06/05/2020
Last updated
06/05/2020
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