Organization
IDAHO SPORTS BRACING INC
Active
Organization
IDAHO SPORTS BRACING INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANNETTE M PETERSON (SECRETARY TREASURER)
(208) 887-9071
Entity
Organization
Contact information
Practice address
711 N RALSTIN ST, MERIDIAN, ID 83642-4079
(208) 887-9071
(208) 887-9235
Mailing address
PO BOX 625, MERIDIAN, ID 83680-0625
(208) 887-9071
(208) 887-9235
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
06/19/2009
Last updated
06/19/2009
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