Individual
JACKIE HENRY
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
6749 W EDEN CT, RATHDRUM, ID 83858-6423
(208) 687-2156
Mailing address
6749 W EDEN CT, RATHDRUM, ID 83858-6423
(208) 687-2156
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-258
ID
Other
Enumeration date
04/27/2006
Last updated
07/08/2007
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