Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT767 | ID |
NPI | 1184142333 |
---|---|
Provider Name | Christine Louise Olen |
First Address | Boise, ID 83706-6928 |
Second Address | Boise, ID 83704-9342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2017 |
Last Update Date | 16/06/2018 |