Provider Demographics
NPI:1043928971
Name:TURNER, KAI LAMONT (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:KAI
Middle Name:LAMONT
Last Name:TURNER
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 N COOL RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3685
Mailing Address - Country:US
Mailing Address - Phone:208-921-4662
Mailing Address - Fax:
Practice Address - Street 1:2204 E LANARK ST STE 100
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5916
Practice Address - Country:US
Practice Address - Phone:208-908-7908
Practice Address - Fax:208-908-7935
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-8166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty