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MRS. DAELENE SUEANN TIBBITTS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PTA

Contact information

Practice address
1665 E 5TH N, MOUNTAIN HOME, ID 83647
(208) 598-5047
Mailing address
1665 E 5TH N, MOUNTAIN HOME, ID 83647
(208) 598-5047

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-4637
ID

Other

Enumeration date
10/25/2016
Last updated
10/25/2016
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