Individual
ALICIA CARLISLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1055 N CURTIS RD, BOISE, ID 83706-1309
(469) 363-6875
Mailing address
4847 W TARGEE ST, BOISE, ID 83705-3656
(469) 363-6875
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-10167026
OR
2255A2300X
Athletic Trainer
Primary
AT-537
ID
Other
Enumeration date
01/06/2015
Last updated
01/06/2015
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