Individual
DR. SHANE NISSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
629 GRANADA RD, CARROLL, IA 51401-1709
(712) 210-2147
Mailing address
629 GRANADA RD, CARROLL, IA 51401-1709
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
004889
IA
225100000X
Physical Therapist
9706
AZ
Other
Enumeration date
01/30/2013
Last updated
01/30/2013
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