Individual
BRANDI GUSTAFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 489-4444
Mailing address
12172 W HAVENCREST DR, STAR, ID 83669-5820
(619) 206-5466
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
08/15/2019
Last updated
08/15/2019
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