Individual
MRS. COREEN WISTISEN KELLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
560 SHOUP AVE W, TWIN FALLS, ID 83301-5029
(208) 737-2126
Mailing address
2168 HILLCREST DR, TWIN FALLS, ID 83301-5364
(208) 734-9353
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-1441
ID
Other
Enumeration date
11/21/2008
Last updated
11/21/2008
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