Basic Information
| Provider Information | |||||||||
| NPI: | 1417456815 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MURDOCK | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7550 W EMERALD ST | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083753765 | ||||||||
| FaxNumber: | 2083752996 | ||||||||
| Practice Location | |||||||||
| Address1: | 809 S WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | EMMETT | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836173528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083655341 | ||||||||
| FaxNumber: | 2083655343 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT5614 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.