Individual
MS. KATHY GAMMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RPT,P.A.
Contact information
Practice address
555 W 25TH ST, IDAHO FALLS, ID 83402-4527
(208) 524-1550
(208) 523-3148
Mailing address
555 W 25TH ST, IDAHO FALLS, ID 83402-4527
(208) 524-1550
(208) 523-3148
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT560
ID
Other
Enumeration date
04/12/2007
Last updated
07/08/2007
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