| NPI | 1225180110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE CHRISTIAN MANGRUM Owner 208-535-4343 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: ID M9189) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2007-11-15 |