Shantay Anderson
Physical Therapy Assistant in Pocatello, ID. Individual provider (NPI-1).
NPI number1942829205
StatusActive
Last updated in NPPESApr 15, 2020
Details
- NPI
- 1942829205
- Entity type
- Individual (NPI-1)
- Name
- Shantay Anderson
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Apr 15, 2020
- Certification date
- Apr 15, 2020
- Last updated
- Apr 15, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225200000X | Physical Therapy Assistant | PTA-6180 | ID | Yes |
| 225200000X | Physical Therapy Assistant | 11433285-2402 | UT |
Practice location
527 Memorial DrPocatello, ID 83201-4063
Phone 208-478-3333
Mailing address
5277 Stuart AvePocatello, ID 83202-2201
Phone 208-760-7975
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All 27 Physical Therapy Assistant providers in Pocatello · All 2,770 providers in Pocatello
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