Provider Demographics
NPI:1275503757
Name:BOALDIN, TRISTAN (DPT)
Entity Type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:BOALDIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 PRAIRIE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-8155
Mailing Address - Country:US
Mailing Address - Phone:319-222-2901
Mailing Address - Fax:319-222-2991
Practice Address - Street 1:5100 PRAIRIE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-8155
Practice Address - Country:US
Practice Address - Phone:319-222-2901
Practice Address - Fax:319-222-2991
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03757OtherIOWA PT LICENSE