Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT-902 | ID |
NPI | 1184823684 |
---|---|
Provider Name | Mrs. Carol Ann Kontos |
First Address | Coeur D Alene, ID 83814-2610 |
Second Address | Coeur D Alene, ID 83814-2610 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 13/07/2007 |