Organization
SENIORLIFE THERAPY CLINIC, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL A GRAGERT (DIRECTOR)
(208) 841-7457
Entity
Organization
Contact information
Practice address
4987 S WILDBROOK WAY, BOISE, ID 83709-5279
(208) 841-7457
Mailing address
4987 S WILDBROOK WAY, BOISE, ID 83709-5279
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
03/24/2009
Last updated
03/24/2009
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