Individual
CHARLES SANDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
7550 W EMERALD ST, BOISE, ID 83704-9015
(208) 375-0666
(208) 375-2996
Mailing address
7550 W EMERALD ST, BOISE, ID 83704-9015
(208) 375-0666
(208) 375-2996
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT538
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006921
BLUE SHIELD OF IDAHO
ID
01
—
T8067
BLUE CROSS OF IDAHO
ID
Enumeration date
06/21/2006
Last updated
07/09/2007
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