Individual
MS. JODY ALISON THATCHER BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
2302 N BOGUS BASIN RD, SUITE C, BOISE, ID 83702-0902
(208) 344-0737
(208) 344-0759
Mailing address
2302 N BOGUS BASIN RD, SUITE C, BOISE, ID 83702-0902
(208) 344-0737
(208) 344-0759
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1137
ID
2251X0800X
Orthopedic Physical Therapist
PT-1137
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807030700
—
ID
Enumeration date
12/22/2006
Last updated
04/25/2010
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