Provider Demographics
NPI:1790119436
Name:POKALLUS, DAVID CLAY (DPT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLAY
Last Name:POKALLUS
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:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-300-1612
Practice Address - Street 1:8 W DRY CREEK CIR STE 130
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4477
Practice Address - Country:US
Practice Address - Phone:303-955-8163
Practice Address - Fax:720-387-7244
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPT-1625225100000X
CO0012253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO319566YMKTMedicare PIN