Individual
TRACY A TATHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3277 E LOUISE DR STE 410, MERIDIAN, ID 83642-9360
(208) 489-5800
Mailing address
2736 W PEAR APPLE ST, KUNA, ID 83634-4753
(208) 376-7548
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-725
ID
Other
Enumeration date
09/05/2024
Last updated
09/05/2024
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