Provider Demographics
NPI:1831341288
Name:GAMES, JENNIFER (PT, L AC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GAMES
Suffix:
Gender:F
Credentials:PT, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 OVERLAND RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3073
Mailing Address - Country:US
Mailing Address - Phone:208-377-1455
Mailing Address - Fax:
Practice Address - Street 1:6003 OVERLAND RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3073
Practice Address - Country:US
Practice Address - Phone:208-377-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-220171100000X
IDPT-2224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist