Healthcare Provider Details

I. General information

NPI: 1821497975
Provider Name (Legal Business Name): DYAN SCHILLING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N CURTIS RD 204
BOISE ID
83706-1338
US

IV. Provider business mailing address

901 N CURTIS RD 204
BOISE ID
83706-1338
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-3315
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number3670
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: