Individual
KEVIN KEITH TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, ATC
Contact information
Practice address
6485 W INTERCHANGE, SUITE 103, BOISE, ID 83709
(208) 440-2488
Mailing address
8157 W GALILEO ST, BOISE, ID 83709-7899
(208) 440-2488
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-212
ID
Other
Enumeration date
10/19/2006
Last updated
07/08/2007
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