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Individual

LESTER BARROSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
895 N 6TH E, MOUNTAIN HOME, ID 83647-2207
(208) 602-0198
Mailing address
4391 S AXIOM AVE, BOISE, ID 83716-5626

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-3272
ID

Other

Enumeration date
11/29/2013
Last updated
11/29/2013
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