Healthcare Provider Details

I. General information

NPI: 1851664643
Provider Name (Legal Business Name): KEVIN SPIEGEL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 W CHERRY LN STE D
MERIDIAN ID
83642
US

IV. Provider business mailing address

901 N CURTIS RD STE 204
BOISE ID
83706-1340
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-8593
  • Fax: 208-367-8595
Mailing address:
  • Phone: 208-367-3315
  • Fax: 208-367-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT-2559
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: