Individual
KAITLIN BAILEY LIVESAY VAIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
921 S 8TH AVE STOP 8045, POCATELLO, ID 83201-5377
(208) 282-4095
Mailing address
921 S 8TH AVE STOP 8045, POCATELLO, ID 83201-5377
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-5241
ID
Other
Enumeration date
08/09/2017
Last updated
08/09/2017
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