Individual
HAILEY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
120 E PINE ST, CALDWELL, ID 83605-4836
(208) 454-5142
Mailing address
2021 N EUREKA AVE, MERIDIAN, ID 83646-3868
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-5637
ID
Other
Enumeration date
11/03/2025
Last updated
11/03/2025
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