Individual
SHANNON F BURBANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1127 CALDWELL BLVD, NAMPA, ID 83651-1701
(209) 465-4935
Mailing address
2697 W LOS FLORES CT, MERIDIAN, ID 83646-5468
(120) 888-4382
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5839
ID
Other
Enumeration date
10/12/2018
Last updated
10/12/2018
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