NPI 1215270053

Crista Ann Jardine, PTA

Practitioner Contractor Ammon, ID

Practice location

Address: 2499 Fieldstone Dr, Ammon, ID 83401-5854
Phone: (208) 681-6677
Fax: (208) 209-8574

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence PTA-110 (ID)

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Registry record

NPI: 1215270053
Entity type: Individual
Sex (as registered): Female
NPI issued: 29 Mar 2013
Record last updated: 29 Mar 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.