Provider Demographics
NPI:1134814072
Name:OSBORNE, MERENCI LYNN
Entity type:Individual
Prefix:
First Name:MERENCI
Middle Name:LYNN
Last Name:OSBORNE
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 1:100 S GENEVA RD UNIT M203
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-5668
Mailing Address - Country:US
Mailing Address - Phone:208-240-0002
Mailing Address - Fax:
Practice Address - Street 1:94 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SANTAQUIN
Practice Address - State:UT
Practice Address - Zip Code:84655
Practice Address - Country:US
Practice Address - Phone:801-754-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist