Individual
KENDRICK JUSTIN KING GUNNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3330 E LOUISE DR STE 400, MERIDIAN, ID 83642-5123
(208) 706-2333
Mailing address
3330 E LOUISE DR STE 400, MERIDIAN, ID 83642-5123
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-4208
ID
Other
Enumeration date
07/08/2019
Last updated
07/08/2019
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