Provider Demographics
NPI:1245564004
Name:ALFS, DONNA STARODOJ (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:STARODOJ
Last Name:ALFS
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:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:KETCHUM
Mailing Address - State:ID
Mailing Address - Zip Code:83340-0850
Mailing Address - Country:US
Mailing Address - Phone:208-720-5859
Mailing Address - Fax:208-725-0203
Practice Address - Street 1:128 5TH AVE W
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-1863
Practice Address - Country:US
Practice Address - Phone:208-324-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist