Individual
NICKALUS SHANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1010 S ALLANTE PL STE 101, BOISE, ID 83709-1660
(208) 370-5166
Mailing address
1010 S ALLANTE PL STE 101, BOISE, ID 83709-1660
(208) 370-5166
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5619
ID
Other
Enumeration date
10/23/2018
Last updated
04/18/2023
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