Individual
REAGAN E FERNLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
134 E IDAHO AVE, HOMEDALE, ID 83628-5003
(208) 337-3254
Mailing address
1217 S BENEWAH ST, NAMPA, ID 83686-2868
(651) 788-0664
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
8554
ID
Other
Enumeration date
02/20/2024
Last updated
02/20/2024
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