Individual
BENJAMIN DOUGLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
120 E PINE ST, CALDWELL, ID 83605-4836
(208) 454-5142
(208) 454-5148
Mailing address
1560 S CAROL ST, MERIDIAN, ID 83646-1839
(208) 288-1155
(208) 288-0424
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-3563
ID
Other
Enumeration date
05/16/2014
Last updated
05/16/2014
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