Healthcare Provider Details

I. General information

NPI: 1871029660
Provider Name (Legal Business Name): KEEGAN PARMER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 MIDWAY DR
AMMON ID
83406-6799
US

IV. Provider business mailing address

3940 N MCKIBBEN LN
IONA ID
83427-7721
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-1715
  • Fax:
Mailing address:
  • Phone: 208-529-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-5203
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: