Individual
MADISON AMEZQUITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1673 W SHORELINE DR STE 230, BOISE, ID 83702-6752
(208) 343-4700
Mailing address
16183 BECKLEY CT, NAMPA, ID 83687-8339
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-8059
ID
2251X0800X
Orthopedic Physical Therapist
PT-8059
ID
Other
Enumeration date
06/01/2022
Last updated
12/12/2023
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