Individual
BRANDON PHOENIX KALLGREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3155 CHANNING WAY STE D, IDAHO FALLS, ID 83404-7875
(208) 973-4170
Mailing address
198 WHITTIER ST, IDAHO FALLS, ID 83402-2207
(208) 360-6955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5171576
ID
Other
Enumeration date
08/08/2025
Last updated
08/08/2025
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