Individual
MS. SHEREE LYNN DIBIASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
8238 N GOVERNMENT WAY, HAYDEN, ID 83835-5034
(208) 762-2100
(208) 762-2101
Mailing address
8238 N GOVERNMENT WAY, HAYDEN, ID 83835-5034
(208) 762-2100
(208) 762-2101
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-629
ID
2251X0800X
Orthopedic Physical Therapist
PT-629
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002734700
—
ID
Enumeration date
11/30/2006
Last updated
08/01/2024
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