Individual
MARY VANORDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPT
Contact information
Practice address
1246 YELLOWSTONE AVE STE F2, POCATELLO, ID 83201-4372
(208) 904-1270
(208) 904-1270
Mailing address
1246 YELLOWSTONE AVE STE F2, POCATELLO, ID 83201-4372
(208) 904-1270
(208) 904-1270
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA-368
ID
225500000X
Respiratory/Developmental/Rehabilitative Specialist/Technologist
Primary
T178488
ID
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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