Provider Demographics
NPI:1669500187
Name:AIRA, DARIAN JENNIFER (PT)
Entity Type:Individual
Prefix:
First Name:DARIAN
Middle Name:JENNIFER
Last Name:AIRA
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 1:5176 S HAPPY TRL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9193
Mailing Address - Country:US
Mailing Address - Phone:520-458-2556
Mailing Address - Fax:
Practice Address - Street 1:5176 S HAPPY TRL
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85650-9193
Practice Address - Country:US
Practice Address - Phone:520-458-2556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56722251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635691Medicaid