Individual
KALA CELESTE WHITWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1520 W STATE ST STE 210, BOISE, ID 83702-4085
(208) 336-8433
(208) 336-8441
Mailing address
1520 W STATE ST STE 210, BOISE, ID 83702-4085
(208) 336-8433
(208) 336-8441
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-2700
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1619283975
NPI
—
05
—
1619283975-000
—
ID
Enumeration date
08/25/2010
Last updated
02/13/2012
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