Provider Demographics
NPI:1093407264
Name:ASH, KIRSTEN MICHELLE (DPT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MICHELLE
Last Name:ASH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:MICHELLE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-969-9945
Mailing Address - Fax:
Practice Address - Street 1:554 N STEELHEAD WAY STE 162
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8388
Practice Address - Country:US
Practice Address - Phone:208-323-9747
Practice Address - Fax:208-323-9752
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID8510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist