Provider Demographics
NPI:1235630732
Name:FLANNERY, EMILY ANNE (MAL, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:FLANNERY
Suffix:
Gender:F
Credentials:MAL, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 S AMERICANA BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6754
Mailing Address - Country:US
Mailing Address - Phone:208-489-5543
Mailing Address - Fax:
Practice Address - Street 1:703 S AMERICANA BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6754
Practice Address - Country:US
Practice Address - Phone:208-489-5543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-5502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer