Individual
NICOLE BARNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1520 W STATE ST, STE 210, BOISE, ID 83702-4085
(208) 336-8433
(208) 336-8441
Mailing address
16083 SW UPPER BOONES FERRY RD, SUITE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1831
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0330319
WA L&I
ID
05
—
1871769307
—
ID
Enumeration date
05/05/2008
Last updated
10/09/2014
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