Individual
MRS. KATHRYN LYNETTE WALLENTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
860 W SHERWOOD ST, APT 150, BOISE, ID 83706-2883
(208) 585-4133
Mailing address
860 W SHERWOOD ST, APT 150, BOISE, ID 83706-2883
(208) 585-4133
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-2882
ID
Other
Enumeration date
12/03/2012
Last updated
12/03/2012
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