Individual
MR. KENNETH RYAN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT, CSCS
Contact information
Practice address
754 N COLLEGE RD STE D, TWIN FALLS, ID 83301-5822
(208) 734-5313
(208) 736-1582
Mailing address
754 N COLLEGE RD STE D, TWIN FALLS, ID 83301-5822
(208) 734-5313
(208) 736-1582
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT6392
ID
Other
Enumeration date
05/14/2019
Last updated
05/14/2019
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