Individual
MRS. JONI D VAUGHN POWELL
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
1951 BENCH RD, SUITE E, POCATELLO, ID 83201-2073
(208) 237-2080
(208) 237-1084
Mailing address
1951 BENCH RD, SUITE E, POCATELLO, ID 83201-2073
(208) 237-2080
(208) 237-1084
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT - 763
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010025951
NDPT REGENCE OF ID
ID
01
—
T4678
NDPT BLUE CROSS OF ID
ID
Enumeration date
04/07/2006
Last updated
07/09/2007
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