Individual
LYDIA JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
717 N LIBERTY ST, BOISE, ID 83704-9342
(208) 367-8989
Mailing address
4002 W PEAK CLOUD DR, MERIDIAN, ID 83642-5377
(701) 306-2946
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7376
ID
Other
Enumeration date
07/20/2021
Last updated
07/20/2021
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