Organization
FOOTHILLS REHABILITATION & PERFORMANCE SERVICES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT KENNEDY DPT (OWNER/MANAGER)
(208) 529-2255
Entity
Organization
Contact information
Practice address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
(208) 529-2022
Mailing address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
(208) 529-2022
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1740
ID
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
Other
Enumeration date
07/14/2014
Last updated
09/05/2014
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