Individual
RAYMOND WAYNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3054 SANDSTONE DR, IDAHO FALLS, ID 83404-6824
(208) 522-0838
Mailing address
3054 SANDSTONE DR, IDAHO FALLS, ID 83404-6824
(208) 522-0838
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2712
ID
Other
Enumeration date
09/19/2015
Last updated
09/19/2015
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