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Individual

LOGAN ELLIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
703 S AMERICANA BLVD STE 120, BOISE, ID 83702-6754
(208) 489-5543
Mailing address
9630 W LEO CT, BOISE, ID 83709-8250

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-641
ID

Other

Enumeration date
02/08/2017
Last updated
03/17/2018
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