Individual
JUSTIN THOMAS KANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1172 W HAYDEN AVE, HAYDEN, ID 83835-8700
(208) 762-3332
(208) 762-4268
Mailing address
1917 N LAKEWOOD DR, COEUR D ALENE, ID 83814-2634
(208) 664-8194
(208) 667-1847
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-700
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100007419
BLUE SHIELD
ID
05
—
004401801
—
ID
01
—
0100472
WASHINGTON LABOR & INDUST
WA
01
—
T5501
BLUE CROSS
ID
Enumeration date
07/04/2006
Last updated
03/06/2009
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