Provider Demographics
NPI:1629939061
Name:DEIST, DARREN M (PTA)
Entity type:Individual
Prefix:MR
First Name:DARREN
Middle Name:M
Last Name:DEIST
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 STEAMBOAT LN APT 101
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3258
Mailing Address - Country:US
Mailing Address - Phone:573-620-2906
Mailing Address - Fax:
Practice Address - Street 1:129 STEAMBOAT LN APT 101
Practice Address - Street 2:APT 101
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3258
Practice Address - Country:US
Practice Address - Phone:573-620-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation