Provider Demographics
NPI:1326263179
Name:SKROH, KIRA ANN (ATC ATL)
Entity Type:Individual
Prefix:MS
First Name:KIRA
Middle Name:ANN
Last Name:SKROH
Suffix:
Gender:F
Credentials:ATC ATL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8634 W WALL DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5873
Mailing Address - Country:US
Mailing Address - Phone:208-761-0713
Mailing Address - Fax:
Practice Address - Street 1:1407 E HOMEDALE RD
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83607-1848
Practice Address - Country:US
Practice Address - Phone:208-454-9253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-2492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer