Individual
JACOB L LAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
909 RESERVE ST., BOISE, ID 83712
(208) 343-7717
(208) 336-4629
Mailing address
4560 SE INTERNATIONAL WAY, STE. 100, MILWAUKIE, OR 97222
(971) 206-5200
(971) 206-5203
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-370
ID
Other
Enumeration date
02/13/2012
Last updated
02/13/2012
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