Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 2400 | ID |
NPI | 1003248923 |
---|---|
Provider Name | Kyle Aaron Holbrook |
First Address | Boise, ID 83706-5503 |
Second Address | Boise, ID 83702-4565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2013 |
Last Update Date | 01/08/2013 |