Provider Demographics
NPI:1003418765
Name:GILLESPIE, KENNEDY POPLAWSKI (DPT)
Entity Type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:POPLAWSKI
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:90 E USTICK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6134
Mailing Address - Country:US
Mailing Address - Phone:208-895-0715
Mailing Address - Fax:208-895-0746
Practice Address - Street 1:90 E USTICK RD STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6134
Practice Address - Country:US
Practice Address - Phone:208-895-0715
Practice Address - Fax:208-895-0746
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299461225100000X
ID7973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist