MEDICARE: KATHRYN GAIL HARBACHECK ATC

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		ID

General Provider Information

NPI Number	:	1801162193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN GAIL HARBACHECK ATC

Provider Business Mailing Address
First Line	:	7312 CHILACOT DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-6006
Country	:	US
Telephone Number	:	208-863-9991
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 W FAIRVIEW AVE
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83702-6722
Country	:	US
Telephone Number	:	208-863-9991
Fax Number	:

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

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	05/05/2025

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