Basic Information
| Provider Information | |||||||||
| NPI: | 1316379662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEARLE | ||||||||
| FirstName: | SHANE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1444 FALLS AVE E | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087362574 | ||||||||
| FaxNumber: | 2087362594 | ||||||||
| Practice Location | |||||||||
| Address1: | 1444 FALLS AVE E | ||||||||
| Address2: | |||||||||
| City: | TWIN FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833013408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087362574 | ||||||||
| FaxNumber: | 2087362594 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2013 | ||||||||
| LastUpdateDate: | 08/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-3286 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.