Individual
TARA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.T
Contact information
Practice address
131 CONSTITUTION WAY, NAMPA, ID 83686-6018
(208) 463-5570
Mailing address
512 E KRALL ST, BOISE, ID 83712-6337
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT-2995
ID
Other
Enumeration date
12/04/2012
Last updated
12/04/2012
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