Individual
DEAN CISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
700 S MAIN ST, MOSCOW, ID 83843-3056
(208) 882-4511
Mailing address
448 GREENSIDES PL, MOSCOW, ID 83843-5009
(808) 312-7407
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
64348
OR
225100000X
Physical Therapist
Primary
7957
ID
Other
Enumeration date
05/26/2023
Last updated
05/26/2023
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