Individual
SELENE BONNELL-HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 A STREET, PLUMMER, ID 83851
(208) 686-7041
(208) 686-5712
Mailing address
1765 FAIRFIELD RD, PLUMMER, ID 83851-9517
(208) 686-0688
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-4116
ID
Other
Enumeration date
11/10/2015
Last updated
11/10/2015
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