Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT390 | ID |
N | 2251N0400X | Physical Therapist - Neurology | PT 390 | ID |
NPI | 1548482664 |
---|---|
Provider Name | Ms. Nancy L Devine |
First Address | Pocatello, ID 83201-2853 |
Second Address | Pocatello, ID 83209-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |