Individual
SHAWNA DENISE BOTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
8211 W USTICK RD, BOISE, ID 83704-5756
(208) 375-3700
(208) 639-3048
Mailing address
8211 W USTICK RD, BOISE, ID 83704-5756
(208) 375-3700
(208) 639-3048
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-362
ID
Other
Enumeration date
11/26/2012
Last updated
11/26/2012
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