Individual
JAMES IAN SANDERCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
520 S EAGLE RD, MERIDIAN, ID 83642-6351
(208) 706-2663
Mailing address
3163 E SWEETWATER DR, BOISE, ID 83716-5664
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-399
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS
ID
Enumeration date
11/21/2017
Last updated
11/21/2017
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