Individual
LAUREN OLIVIA VANGORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
5418 N EAGLE RD STE 170, BOISE, ID 83713-0999
(208) 501-8264
(208) 514-1558
Mailing address
8048 WATERCRESS AVE, NAMPA, ID 83687-8289
(219) 713-2486
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6706
ID
Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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