Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | ID |
NPI | 1124695614 |
---|---|
Provider Name | Stephen Zahner III |
First Address | Ammon, ID 83406-5092 |
Second Address | Idaho Falls, ID 83404-8237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |