Provider Demographics
NPI:1104507102
Name:SHINE THERAPIES PLLC
Entity type:Organization
Organization Name:SHINE THERAPIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-389-8387
Mailing Address - Street 1:6010 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-3013
Mailing Address - Country:US
Mailing Address - Phone:208-901-5278
Mailing Address - Fax:
Practice Address - Street 1:6010 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3013
Practice Address - Country:US
Practice Address - Phone:208-901-5278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty