Individual
FORREST Q PECHA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, LAT, OTC
Contact information
Practice address
1109 W MYRTLE ST, SUITE 200, BOISE, ID 83702-6970
(208) 489-4331
Mailing address
12664 N 13TH AVE, BOISE, ID 83714-5061
(208) 908-1236
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT-391
ID
2255A2300X
Athletic Trainer
Primary
AT001169
GA
246ZS0410X
Surgical Technologist
02 5855
GA
Other
Enumeration date
06/07/2007
Last updated
06/09/2011
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