Individual
MRS. NICOLLE LENNA GLEASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
5640 E FRANKLIN RD # B, NAMPA, ID 83687-8402
(208) 484-4640
(208) 484-4685
Mailing address
3403 W LASSEN ST, BOISE, ID 83703-4734
(208) 869-8036
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2098
ID
Other
Enumeration date
04/30/2012
Last updated
04/30/2012
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