Individual
BRADLEY DALE ALLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT, ATC
Contact information
Practice address
1910 UNIVERSITY DR, BOISE, ID 83725-1711
(208) 426-2305
Mailing address
1910 UNIVERSITY DR, BOISE, ID 83725-1711
(208) 426-2305
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-413
ID
Other
Enumeration date
05/09/2012
Last updated
05/09/2012
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