Individual
JONATHAN BRUBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1003 N ORCHARD ST, BOISE, ID 83706-2231
(208) 376-3113
Mailing address
1750 S LINDER RD UNIT E202, MERIDIAN, ID 83642-7396
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7324
ID
Other
Enumeration date
08/02/2021
Last updated
11/10/2021
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