Idaho
Division of Occupational and Professional Licenses
SHANE RUSSELL DIBIASE
Physical Therapy Licensure Board - Physical Therapist Assistant
License number
PTA - 4555
Date granted
04/13/2016
Date expires
05/15/2017
Class
Physical Therapy Licensure Board - Physical Therapist Assistant
Status
Current
Address
HAYDEN ID 83835
idaholicensing.com
ID 43733986
LAST UPDATED 2024-03-23 03:29:20 UTC
LAST UPDATED 2024-03-23 03:29:20 UTC
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