Individual
MARISSA SHUPPERD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
775 S RIVERSHORE LN STE 220, EAGLE, ID 83616-5783
(208) 435-8662
Mailing address
775 S RIVERSHORE LN STE 220, EAGLE, ID 83616-5783
(208) 435-8662
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
01/26/2024
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