Organization
WESTERN CENTER FOR REHABILITATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE CHRISTIAN MANGRUM M.D. (OWNER)
(208) 535-4343
Entity
Organization
Contact information
Practice address
2860 CHANNING WAY, 114, IDAHO FALLS, ID 83404-7531
(208) 535-4343
(208) 535-4344
Mailing address
2860 CHANNING WAY, 114, IDAHO FALLS, ID 83404-7531
(208) 535-4343
(208) 535-4344
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
M9189
ID
Other
Enumeration date
01/18/2007
Last updated
11/15/2007
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