Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT-2054 | ID |
N | 2251G0304X | Physical Therapist - Geriatrics | PT-2054 | ID |
NPI | 1396951208 |
---|---|
Provider Name | Miss Reema Arun Khanolkar |
First Address | Boise, ID 83704-8894 |
Second Address | Boise, ID 83704-8700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |