Individual
SHAYNE J BOLLHEIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1022 E WESLEY DR, O FALLON, IL 62269-6107
(618) 744-6613
Mailing address
49 WALNUT CIR, AVISTON, IL 62216-3537
(618) 929-2709
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160003017
IL
Other
Enumeration date
01/22/2024
Last updated
01/22/2024
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