Individual
JACQUELYN ROSE MALLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
6186 W MAINE ST, SPIRIT LAKE, ID 83869-0149
(208) 449-1596
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 763-0485
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-9060
ID
Other
Enumeration date
06/03/2024
Last updated
06/03/2024
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