Individual
STEPHANIE LIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
3125 VALENCIA DR, IDAHO FALLS, ID 83404-7575
(208) 529-3332
(208) 529-3336
Mailing address
1940 S BONITO WAY STE 190, MERIDIAN, ID 83642-5618
(208) 287-9420
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-954
ID
2255A2300X
Athletic Trainer
AT-077
ID
Other
Enumeration date
10/29/2007
Last updated
03/14/2023
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