Provider Demographics
NPI:1003650250
Name:RICE, JENNIFER LYNN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:RICE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 N WHISTLER LN APT 107
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-6903
Mailing Address - Country:US
Mailing Address - Phone:208-404-8400
Mailing Address - Fax:
Practice Address - Street 1:2619 W FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6722
Practice Address - Country:US
Practice Address - Phone:208-706-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-9112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer