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Individual

JESSE DALE NEWMAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
5909 W STATE ST, BOISE, ID 83703-3039
(208) 343-7700
(208) 331-2591
Mailing address
5909 W STATE ST, BOISE, ID 83703-3039
(208) 343-7700
(208) 331-2591

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-5990
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PTA-5990
PHYSICAL THERAPIST ASSISTANT
ID
Enumeration date
04/03/2019
Last updated
11/27/2023
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