Individual
STACEY L SCANLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2302 N BOGUS BASIN ROAD, SUITE C, BOISE, ID 83702
(208) 344-0730
(208) 344-0759
Mailing address
2302 N BOGUS BASIN ROAD, SUITE C, BOISE, ID 83702
(208) 344-0737
(208) 344-0759
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1355
ID
2251X0800X
Orthopedic Physical Therapist
PT1355
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102560035
—
ID
01
—
1578799094
THRIVE PT AND PILATES GROUP NPI
—
Enumeration date
10/19/2006
Last updated
10/07/2011
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