| NPI | 1063829836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENT KENNEDY Owner/Manager 208-529-2255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1740) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| 235Z00000X Speech-Language Pathologist, | |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-09-05 |