Basic Information
| Provider Information | |||||||||
| NPI: | 1790802643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALLISON | ||||||||
| FirstName: | LORIE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | ATC, ATL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4803 W MYSTIC COVE DR | ||||||||
| Address2: | |||||||||
| City: | GARDEN CITY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837144785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084040730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 ROBBINS RD | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837024539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2084894040 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 069 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.