Individual
THOMAS HENRIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AT
Contact information
Practice address
3960 STOCKMAN RD., POCATELLO, ID 83204
(208) 851-1213
Mailing address
3960 STOCKMAN RD, POCATELLO, ID 83204-2004
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-613
ID
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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