Healthcare Provider Details

I. General information

NPI: 1053449843
Provider Name (Legal Business Name): NEIL KUGLER PT, AT,C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2658 S SWALLOWTAIL LN
BOISE ID
83706-6132
US

IV. Provider business mailing address

2658 S SWALLOWTAIL LN
BOISE ID
83706-6132
US

V. Phone/Fax

Practice location:
  • Phone: 208-389-1289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT506
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: