Individual
MR. KEEGAN NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MS, ATC, SPT
Contact information
Practice address
554 N STEELHEAD WAY STE 162, BOISE, ID 83704-8388
(208) 323-9747
(208) 323-9752
Mailing address
100 S LOCUST GROVE RD UNIT O101, MERIDIAN, ID 83642-6389
(618) 789-5704
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7532
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/29/2015
Last updated
08/17/2021
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