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General NPI Number Information
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NPI Number | 1659429405
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Entity Type | Organization
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Legal Business Name | BK INC.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 08/17/2007
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Provider Practice Location Address
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Address Line | 872 TROY RD STE 180
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City | MOSCOW
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State | ID
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Zip | 83843-4046
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Country | US
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Telephone | 208-882-1426
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Fax | 208-882-1428
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Provider Business Mailing Address
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Address Line | 872 TROY RD STE 180
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City | MOSCOW
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State | ID
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Zip | 83843-4046
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Country | US
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Telephone | 208-882-1426
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Fax | 208-882-1428
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Authorized Official
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Title or Position | OWNER
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Name | KELLY ISAKSON
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Credential | PT
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Telephone | 208-882-1426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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