Provider Demographics
NPI:1922452614
Name:BRINKMAN, KENNA (PT)
Entity Type:Individual
Prefix:
First Name:KENNA
Middle Name:
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5073 E GERANIUM ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-7044
Mailing Address - Country:US
Mailing Address - Phone:208-982-9590
Mailing Address - Fax:
Practice Address - Street 1:5073 E GERANIUM ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83716-7044
Practice Address - Country:US
Practice Address - Phone:208-982-9590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13421134-2401225100000X
225100000X
CAPT 21157225100000X
IDPT-4694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist