Provider Demographics
NPI:1982679304
Name:NATTRESS, KEVIN BRETT (PT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BRETT
Last Name:NATTRESS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N WHITLEY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2705
Mailing Address - Country:US
Mailing Address - Phone:208-452-6366
Mailing Address - Fax:208-452-6399
Practice Address - Street 1:215 N WHITLEY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2705
Practice Address - Country:US
Practice Address - Phone:208-452-6366
Practice Address - Fax:208-452-6399
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1650698Medicare ID - Type Unspecified