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General NPI Number Information
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NPI Number | 1518162957
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Entity Type | Individual
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Provider Name | KATHRYN ELIZABETH MACOMB M.P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/17/2007
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 8660 W EMERALD ST STE 112
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City | BOISE
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State | ID
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Zip | 83704-4829
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Country | US
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Telephone | 208-321-7831
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Fax |
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Provider Business Mailing Address
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Address Line | 856 W CAGNEY ST
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City | MERIDIAN
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State | ID
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Zip | 83646-5297
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Country | US
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Telephone | 208-724-3870
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT-1608
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License Number State | ID
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