Provider Demographics
NPI:1841561768
Name:DARKE, TRISTEN MICHELE
Entity Type:Individual
Prefix:MS
First Name:TRISTEN
Middle Name:MICHELE
Last Name:DARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 ALBANY CT
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4139
Mailing Address - Country:US
Mailing Address - Phone:970-690-8004
Mailing Address - Fax:
Practice Address - Street 1:2205 ALBANY CT
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4139
Practice Address - Country:US
Practice Address - Phone:970-690-8004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist