Healthcare Provider Details

I. General information

NPI: 1275769218
Provider Name (Legal Business Name): KRISTOFF JOSEPH SAURETTE PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8827 N GOVERNMENT WAY UNIT 102
HAYDEN ID
83835-8231
US

IV. Provider business mailing address

8827 N GOVERNMENT WAY UNIT 102
HAYDEN ID
83835-8231
US

V. Phone/Fax

Practice location:
  • Phone: 208-243-9335
  • Fax: 208-475-6454
Mailing address:
  • Phone: 208-243-9335
  • Fax: 208-475-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5779
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMA 60074750
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: