Individual
SHELLEY THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
600 ROBBINS RD, BOISE, ID 83702-4539
(208) 489-4795
Mailing address
9751 GLORIA RD, MIDDLETON, ID 83644-5066
(208) 898-0256
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1492
ID
Other
Enumeration date
05/17/2007
Last updated
07/08/2007
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