Search › Idaho › 2255A2300X
Nicole Clark, LAT, ATC
NPI 1538196563 · on the registry since 2006
Practice
- Address
- 1010 W Washington St
Boise, ID 83702 - Phone
- (208) 854-4270
- Fax
- (208) 854-4271
- Organisation at this address
- Grounded Wellness Pllc
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 5
Registry record
- Primary taxonomy
- 2255A2300X
2255A2300X
- Licence states on file
- ID
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2007-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Idaho