Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT2331 | ID |
NPI | 1003073347 |
---|---|
Provider Name | Peter H Kolb |
First Address | Boise, ID 83706-1340 |
Second Address | Boise, ID 83706-1340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 22/05/2008 |