Individual
RAJCOOMAR ISSUREE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPT
Contact information
Practice address
8950 W EMERALD ST, SUITE #195, BOISE, ID 83704-4854
(208) 376-7313
(208) 376-7487
Mailing address
8950 W EMERALD ST STE 195, BOISE, ID 83704-8296
(208) 376-7313
(208) 376-7487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT670
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138628
REGENCE BLUE SHIELD OF ID
ID
05
—
806834400
—
ID
01
—
TD767
BLUE CROSS OF ID
ID
Enumeration date
07/14/2006
Last updated
03/29/2010
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