Individual
MR. KEVIN CHARLES STANFORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
374 12TH ST, IDAHO FALLS, ID 83404-5369
(208) 201-0432
Mailing address
374 12TH ST, IDAHO FALLS, ID 83404-5369
(208) 201-0432
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1846
ID
Other
Enumeration date
09/06/2007
Last updated
09/06/2007
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