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Individual

LUCAS BAHNMAIER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MS, ATC/L, OTC

Contact information

Practice address
1109 W MYRTLE ST, SUITE 200, BOISE, ID 83702-6970
(208) 489-4299
(208) 489-4300
Mailing address
1109 W MYRTLE ST, SUITE 200, BOISE, ID 83702-6970
(208) 489-4299
(208) 489-4300

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-425
ID

Other

Enumeration date
12/18/2012
Last updated
12/18/2012
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