Individual
HALEY SHOVLIN VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
7550 W EMERALD ST, BOISE, ID 83704-9015
(208) 375-0666
(208) 375-2996
Mailing address
7550 W EMERALD ST, BOISE, ID 83704-9015
(208) 375-0666
(208) 375-2996
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-6814
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT-6814
STATE LICENSE
ID
Enumeration date
06/02/2020
Last updated
10/18/2023
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