Healthcare Provider Details

I. General information

NPI: 1144518937
Provider Name (Legal Business Name): BENJAMIN A KUZNIA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 01/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 N EAGLE RD SUITE 102
BOISE ID
83713-2700
US

IV. Provider business mailing address

1560 S CAROL ST
MERIDIAN ID
83646-1839
US

V. Phone/Fax

Practice location:
  • Phone: 208-938-5255
  • Fax: 208-938-5545
Mailing address:
  • Phone: 208-288-1155
  • Fax: 208-288-0424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2877
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: