Provider Demographics
NPI:1366711129
Name:LARA, GEORGE P (MS RCEP)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:P
Last Name:LARA
Suffix:
Gender:M
Credentials:MS RCEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3525 E. LOUISE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6305
Mailing Address - Country:US
Mailing Address - Phone:208-706-7050
Mailing Address - Fax:208-706-7059
Practice Address - Street 1:3525 E LOUISE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6302
Practice Address - Country:US
Practice Address - Phone:208-706-7050
Practice Address - Fax:208-706-7059
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist