Individual
TONY LANE GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1351 W PINE AVE, MERIDIAN, ID 83642-5031
(208) 888-7049
Mailing address
6155 W VILLA PARK ST, BOISE, ID 83703-6421
(208) 989-6297
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
3660
ID
Other
Enumeration date
03/17/2015
Last updated
03/17/2015
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