Individual
PRESTON CHARLES MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
1001 S HILTON ST, BOISE, ID 83705-1925
(208) 345-4464
Mailing address
5927 S TALLOWTREE WAY, BOISE, ID 83716-6965
(208) 859-1114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1824
ID
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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