Provider Demographics
NPI:1215650122
Name:TURKE, KELLI (PT)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:TURKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8773 W SUTTLE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2085
Mailing Address - Country:US
Mailing Address - Phone:208-602-7095
Mailing Address - Fax:
Practice Address - Street 1:1835 WILDWOOD ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-5146
Practice Address - Country:US
Practice Address - Phone:877-200-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-4941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist