Individual
KATHRYN BLACKADAR OLDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T., DPT
Contact information
Practice address
802 SHOUP ST, SALMON, ID 83467-4305
(208) 756-2005
(208) 756-4020
Mailing address
PO BOX 1107, SALMON, ID 83467-1107
(208) 756-2005
(208) 756-4020
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2694
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20005459
MEDICARE PTAN
ID
Enumeration date
02/12/2014
Last updated
10/21/2016
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