Provider Demographics
NPI:1144877275
Name:SAHWELL, THISBE COSETTE
Entity type:Individual
Prefix:
First Name:THISBE
Middle Name:COSETTE
Last Name:SAHWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 S LOGGERS POND PL APT 23
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-7501
Mailing Address - Country:US
Mailing Address - Phone:302-242-1263
Mailing Address - Fax:
Practice Address - Street 1:1614 S LOGGERS POND PL APT 23
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-7501
Practice Address - Country:US
Practice Address - Phone:302-242-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty