Individual
ALICE LORAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT, OMS
Contact information
Practice address
210 TRIANGLE DR STE E, PONDERAY, ID 83852-9791
(208) 946-5364
(208) 946-5364
Mailing address
210 TRIANGLE DR STE E, PONDERAY, ID 83852-9791
(208) 946-5364
(208) 946-5364
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3693
ID
Other
Enumeration date
03/25/2015
Last updated
11/21/2022
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