Individual
KEVIN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1480 MIDWAY AVE, AMMON, ID 83406-4587
(208) 523-1980
(208) 523-4024
Mailing address
1480 MIDWAY AVE, AMMON, ID 83406-4587
(208) 523-1980
(208) 523-4024
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1160
ID
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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