# WESTERN CENTER FOR REHABILITATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225180110
- **Authorized official:** DR. SHANE CHRISTIAN MANGRUM M.D. (OWNER)
- **Authorized official phone:** (208) 535-4343

## Contact information

- **Practice address:** 2860 CHANNING WAY, 114, IDAHO FALLS, ID 83404-7531
- **Practice address phone:** (208) 535-4343
- **Practice address fax:** (208) 535-4344
- **Mailing address:** 2860 CHANNING WAY, 114, IDAHO FALLS, ID 83404-7531
- **Mailing address phone:** (208) 535-4343
- **Mailing address fax:** (208) 535-4344

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225400000X | Rehabilitation Practitioner | M9189 | ID | Yes |

## Other

- **Enumeration date:** 01/18/2007
- **Last updated:** 11/15/2007