Provider Demographics
NPI:1457687311
Name:RICE, KRISTEN (MT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RICE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:HURST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:7447 W EMERALD ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5003
Mailing Address - Country:US
Mailing Address - Phone:208-344-3744
Mailing Address - Fax:208-344-1222
Practice Address - Street 1:7447 W EMERALD ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5003
Practice Address - Country:US
Practice Address - Phone:208-344-3744
Practice Address - Fax:208-344-1222
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMX090086172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist