Individual
JARED CLIVE SANSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3352 N KINGSWOOD WAY, BOISE, ID 83704-4385
(208) 421-5991
Mailing address
3352 N KINGSWOOD WAY, BOISE, ID 83704-4385
(208) 421-5991
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-4725
ID
Other
Enumeration date
05/17/2021
Last updated
05/17/2021
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