Individual
BRENT SHELDON KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
3715 WOODKING DR, IDAHO FALLS, ID 83404-4720
(208) 529-2255
(208) 529-2022
Mailing address
2335 PTARMIGAN WAY, AMMON, ID 83401-5850
(208) 552-5661
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
RPT-1740
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806757200
—
ID
Enumeration date
04/02/2007
Last updated
08/29/2014
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