Individual
MRS. BREANNA L KUMP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA-288
Contact information
Practice address
993 GRASSLAND DR, IDAHO FALLS, ID 83404-8350
(208) 406-1129
Mailing address
993 GRASSLAND DR, IDAHO FALLS, ID 83404-8350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA-288
ID
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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