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Individual

CLIFFORD KIRACOFE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RPT

Contact information

Practice address
8836 N HESS ST, STE C, HAYDEN, ID 83835-8718
(208) 772-6991
(208) 772-6674
Mailing address
PO BOX 293, HAYDEN, ID 83835-0293
(208) 772-6991
(208) 772-6674

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1579
ID

Other

Enumeration date
07/13/2006
Last updated
03/31/2008
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