Individual
MR. SHANE MICHAEL OSGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC, CEAS
Contact information
Practice address
833 SHOSHONE ST N, TWIN FALLS, ID 83301-6370
(607) 377-7850
Mailing address
PO BOX 2126, TWIN FALLS, ID 83303-2126
(607) 377-7850
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
002043-1
NY
2255A2300X
Athletic Trainer
Primary
AT-509
ID
Other
Enumeration date
12/31/2008
Last updated
09/05/2014
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