Individual
KASSANDRA NOELLE STINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3111 CHANNING WAY, IDAHO FALLS, ID 83404-7534
(208) 529-0067
Mailing address
2475 S AMMON RD APT 207, AMMON, ID 83406-4834
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-3228
ID
Other
Enumeration date
07/28/2017
Last updated
07/28/2017
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