Provider Demographics
NPI:1952654220
Name:LAFORTUNE, KATHLEEN ALLARD (PT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ALLARD
Last Name:LAFORTUNE
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 1:710 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-3504
Mailing Address - Country:US
Mailing Address - Phone:208-301-0690
Mailing Address - Fax:
Practice Address - Street 1:710 E 7TH ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-3504
Practice Address - Country:US
Practice Address - Phone:208-301-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000051782251P0200X
ID6172251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics