Individual
CHAD IVES LEPAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
3812 LA MESITA WAY, BOISE, ID 83702-1537
(208) 385-0350
Mailing address
3812 LA MESITA WAY, BOISE, ID 83702-1537
(208) 385-0350
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-803
ID
Other
Enumeration date
05/18/2007
Last updated
07/08/2007
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