Provider Demographics
NPI:1992856322
Name:DARRAH, KRISTIANE (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIANE
Middle Name:
Last Name:DARRAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRISTIANE
Other - Middle Name:
Other - Last Name:VAN DER LINDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MT
Mailing Address - Zip Code:59644-0005
Mailing Address - Country:US
Mailing Address - Phone:406-431-9593
Mailing Address - Fax:406-266-4105
Practice Address - Street 1:807 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOWNSEND
Practice Address - State:MT
Practice Address - Zip Code:59644-2431
Practice Address - Country:US
Practice Address - Phone:406-431-9593
Practice Address - Fax:406-266-4105
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1190225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0347429Medicaid
MT60688OtherBLUE CROSS BLUE SHIELD