Individual
ROGER DAVIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
A.T.,C.
Contact information
Practice address
690 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4073
(208) 604-0215
Mailing address
2450 VIRLOW ST APT 4, IDAHO FALLS, ID 83401-3314
(208) 604-0215
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-296
ID
Other
Enumeration date
03/03/2007
Last updated
07/08/2007
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