Provider Demographics
NPI:1659429405
Name:BK INC.
Entity Type:Organization
Organization Name:BK INC.
Other - Org Name:MOSCOW MOUNTAIN SPORT AND PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAKSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:208-882-1426
Mailing Address - Street 1:872 TROY RD STE 180
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-4046
Mailing Address - Country:US
Mailing Address - Phone:208-882-1426
Mailing Address - Fax:208-882-1428
Practice Address - Street 1:872 TROY RD STE 180
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-4046
Practice Address - Country:US
Practice Address - Phone:208-882-1426
Practice Address - Fax:208-882-1428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy