Individual
MATTHEW THOMAS JAKSETIC
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1450 AVIATION DR, 201, HAILEY, ID 83333-8785
(208) 727-8281
(208) 727-8285
Mailing address
PO BOX 2561, KETCHUM, ID 83340-2561
(906) 282-4876
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
959039
WI
2255A2300X
Athletic Trainer
Primary
AT-364
ID
Other
Enumeration date
09/23/2009
Last updated
06/15/2010
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