MEDICARE: KOURTNEY SAXTON AT, LAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1265842082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KOURTNEY SAXTON AT, LAT

Provider Business Mailing Address
First Line	:	959 E CONGRESS ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-5561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 E BOISE AVE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-5119
Country	:	US
Telephone Number	:	208-871-1226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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