Individual
SHANE GRAYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
182 FALLS AVE W, TWIN FALLS, ID 83301-3595
(208) 995-7842
Mailing address
182 FALLS AVE W, TWIN FALLS, ID 83301-3595
(208) 995-7842
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-3681
ID
Other
Enumeration date
07/23/2014
Last updated
07/23/2014
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