Individual
MR. DEL TREJO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2078
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-347
ID
Other
Enumeration date
09/12/2016
Last updated
09/12/2016
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