Healthcare Provider Details

I. General information

NPI: 1386000446
Provider Name (Legal Business Name): MARC VROMAN LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S EUCLID AVE
SANDPOINT ID
83864-4912
US

IV. Provider business mailing address

520 N BOYER AVE
SANDPOINT ID
83864-1908
US

V. Phone/Fax

Practice location:
  • Phone: 208-946-1288
  • Fax:
Mailing address:
  • Phone: 208-946-1288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMASG-1420
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: