Individual
KIMBERLEE A PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
172 W MAIN ST, KUNA, ID 83634
(208) 922-9828
(208) 922-3499
Mailing address
PO BOX 711185, SALT LAKE CITY, UT 84171
(801) 942-3311
(801) 942-5955
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT1528
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0027023000
—
ID
Enumeration date
09/01/2006
Last updated
07/08/2007
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