Kennedy, Brent Sheldon

Kennedy, Brent Sheldon is an sole proprietor health care provider with primary practice located at 3715 Woodking Dr , Idaho Falls ID 83404-4720. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Kennedy, Brent Sheldon can be contacted via phone (208) 529-2255.

Contact Information

Primary practice address
3715 Woodking Dr Idaho Falls ID 83404-4720
Phone: (208) 529-2255
Fax: (208) 529-2022
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X RPT-1740 Idaho

Profile Details

NPI number 1295855112
LBN Legal business name Kennedy, Brent Sheldon
Credentials DPT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 2nd, 2007
Last updated Aug 29th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295855112 NPPES
Idaho MEDICAID 806757200

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