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General NPI Number Information
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NPI Number | 1770678484
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Entity Type | Individual
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Provider Name | KEVIN JOHN SGROI P.T.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 8300 N WAYNE DR
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City | HAYDEN
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State | ID
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Zip | 83835-6027
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Country | US
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Telephone | 208-772-9774
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Fax | 208-772-9564
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Provider Business Mailing Address
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Address Line | 8300 N WAYNE DR
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City | HAYDEN
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State | ID
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Zip | 83835-6027
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Country | US
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Telephone | 208-772-9774
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Fax | 208-772-9564
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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 | 1457
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License Number State | ID
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