Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT-5516 | ID |
N | 2251P0200X | Physical Therapist - Pediatrics | PT-5516 | ID |
NPI | 1043717705 |
---|---|
Provider Name | Elizabeth Anne Olorenshaw |
First Address | Twin Falls, ID 83301-6747 |
Second Address | Twin Falls, ID 83301-6747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2018 |
Last Update Date | 10/04/2018 |