Provider Demographics
NPI:1417713348
Name:NEWCOMB, SEAN TALMON (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:TALMON
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 E MEDALIST LN APT 202
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5402
Mailing Address - Country:US
Mailing Address - Phone:509-200-0582
Mailing Address - Fax:
Practice Address - Street 1:901 N CURTIS RD STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1340
Practice Address - Country:US
Practice Address - Phone:509-200-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-8872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer