Individual
MACY VAIL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Contact information
Practice address
921 S 8TH AVE, POCATELLO, ID 83209-0002
(208) 430-1397
Mailing address
921 S 8TH AVE, POCATELLO, ID 83209-0002
(208) 430-1397
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/26/2025
Last updated
02/26/2025
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