Individual
BRENDON REED JUDD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
875 PERIMETER DR, MOSCOW, ID 83844-9803
(208) 827-2186
Mailing address
3013 MEADOWLARK DR, LEWISTON, ID 83501-9668
(208) 827-2186
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
06/01/2018
Last updated
06/01/2018
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