Individual
JOHN C KOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
101 SADDLE ROAD, KETCHUM, ID 83340-1510
(208) 726-9222
(208) 726-1607
Mailing address
PO BOX 1510, KETCHUM, ID 83340-1510
(208) 788-3997
(208) 726-1607
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT614
ID
2251S0007X
Sports Physical Therapist
RPT614
ID
2251X0800X
Orthopedic Physical Therapist
RPT614
ID
Other
Enumeration date
09/29/2006
Last updated
01/17/2014
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