Individual
AMMON BENJAMIN BIRK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
940 BALLARD WAY, KIMBERLY, ID 83341
(801) 874-0479
Mailing address
940 BALLARD WAY, KIMBERLY, ID 83341-5162
(801) 874-0479
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-4245
ID
Other
Enumeration date
04/23/2018
Last updated
06/23/2018
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