Provider Demographics
NPI:1609106483
Name:FLOLO, DAREN (MPT)
Entity Type:Individual
Prefix:
First Name:DAREN
Middle Name:
Last Name:FLOLO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 6TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-2006
Mailing Address - Country:US
Mailing Address - Phone:509-758-8510
Mailing Address - Fax:509-751-9149
Practice Address - Street 1:725 6TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-2006
Practice Address - Country:US
Practice Address - Phone:509-758-8510
Practice Address - Fax:509-751-9149
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00007141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist