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General NPI Number Information
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NPI Number | 1619451275
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Entity Type | Organization
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Legal Business Name | KOKKONEN P M AND R PC
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 04/14/2023
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Provider Practice Location Address
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Address Line | 3372 E JENALAN
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City | POST FALLS
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State | ID
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Zip | 83854-7787
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Country | US
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Telephone | 801-473-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 N HOWELL RD
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City | POST FALLS
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State | ID
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Zip | 83854-8201
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Country | US
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Telephone | 801-473-2261
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY JUHANI KOKKONEN
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Credential | DO
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Telephone | 801-473-2261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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