Individual
KENT WALLINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
600 N ROBBINS RD, BOISE, ID 83702-4565
(208) 381-2222
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT3735
ID
Other
Enumeration date
09/19/2014
Last updated
09/19/2014
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