Individual
MS. JUDITH LEE GRUCELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4477 EMERALD ST STE C125, BOISE, ID 83706-2058
(208) 343-7700
Mailing address
4477 EMERALD ST STE C125, BOISE, ID 83706-2058
(208) 343-7700
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT1173
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T7978
BLUE CROSS
ID
Enumeration date
12/12/2006
Last updated
07/08/2007
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