Provider Demographics
NPI:1477622702
Name:MANSOR-JESS, MARCY B (PT)
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:B
Last Name:MANSOR-JESS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N CURTIS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1340
Mailing Address - Country:US
Mailing Address - Phone:208-367-3315
Mailing Address - Fax:208-367-2674
Practice Address - Street 1:901 N CURTIS RD STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1340
Practice Address - Country:US
Practice Address - Phone:208-367-3315
Practice Address - Fax:208-367-2674
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1889225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist