Individual
KELLY JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8468 N WAYNE DR, HAYDEN, ID 83835-6025
(208) 601-6060
(208) 635-5098
Mailing address
850 W IRONWOOD DR STE 202, COEUR D ALENE, ID 83814-4903
(208) 664-2175
(208) 664-1226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT7061
STATE LICENSE
ID
Enumeration date
12/02/2019
Last updated
12/12/2025
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