Individual
JADE ALIZE GLENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10790 W OVERLAND RD, BOISE, ID 83709-1329
(208) 467-7889
Mailing address
10790 W OVERLAND RD, BOISE, ID 83709-1329
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
9081
ID
Other
Enumeration date
06/06/2024
Last updated
06/06/2024
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