Healthcare Provider Details

I. General information

NPI: 1598697393
Provider Name (Legal Business Name): KALLIE SUE LARSON DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 HIGHWAY 30
FILER ID
83328-9602
US

IV. Provider business mailing address

1411 FALLS AVE E STE 401
TWIN FALLS ID
83301-3455
US

V. Phone/Fax

Practice location:
  • Phone: 208-738-4440
  • Fax: 208-801-6859
Mailing address:
  • Phone: 208-738-4440
  • Fax: 208-801-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number3481913
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: