Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 1860 | ID |
NPI | 1124199443 |
---|---|
Provider Name | Katherine Simpson Rowe |
First Address | Boise, ID 83712-8018 |
Second Address | Boise, ID 83712-8018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 20/02/2020 |