Individual
REBECCA STOUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.T.A
Contact information
Practice address
295 BLACK TAIL LN, GRANGEVILLE, ID 83530-5099
(208) 451-4752
Mailing address
1317 PLUM ST, CHEYENNE, WY 82007-3333
(208) 451-4752
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA2635
ID
225700000X
Massage Therapist
Primary
CCMT-23-71
WY
Other
Enumeration date
02/04/2014
Last updated
03/20/2025
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