Individual
JACOB ADAM LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
960 S BROADWAY AVE STE 200, BOISE, ID 83706-3667
(208) 433-9211
Mailing address
16083 SW UPPER BOONES FERRY RD STE 300, TIGARD, OR 97224-7736
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
04/04/2023
Last updated
04/04/2023
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