Organization
KOTH SPORTS PHYSICAL THERAPY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRI L KOTH (ITS SECRETARY/TREASURER, ITS BUS MG)
(208) 788-3997
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC6231
RAILROAD MEDICARE GROUP
ID
Enumeration date
09/29/2006
Last updated
01/21/2014
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