Individual
ALEXANDRA LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1010 W WASHINGTON ST, BOISE, ID 83702-5446
(208) 854-4270
Mailing address
628 WINTER PL, NAMPA, ID 83686-2988
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000020432
ID
Other
Enumeration date
08/03/2017
Last updated
08/03/2017
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