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NPI Code Detail

MEDICARE: KYLE DONOVAN MAUGHAN DPT

MEDICARE: KYLE DONOVAN MAUGHAN DPT
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
1225100000XPhysical TherapistPT-3478ID

General Provider Information

NPI Number : 1689088726
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE DONOVAN MAUGHAN DPT
Provider Business Mailing Address
First Line : 1001 S HILTON ST
Second Line :
City : BOISE
State : ID
Zip : 83705-1925
Country : US
Telephone Number : 509-552-6910
Fax Number :
Provider Business Practice Location Address
First Line : 1001 S HILTON ST
Second Line :
City : BOISE
State : ID
Zip : 83705-1925
Country : US
Telephone Number : 509-552-6910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2014
Last Update Date : 06/20/2014

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Directions to “ KYLE DONOVAN MAUGHAN DPT” Practice Location

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