Provider Demographics
NPI:1295871945
Name:KROLL, DARLA JEANINE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:DARLA
Middle Name:JEANINE
Last Name:KROLL
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 12TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HOOD RIVER
Mailing Address - State:OR
Mailing Address - Zip Code:97031-1757
Mailing Address - Country:US
Mailing Address - Phone:541-436-4547
Mailing Address - Fax:833-272-3435
Practice Address - Street 1:1406 12TH ST STE 101
Practice Address - Street 2:
Practice Address - City:HOOD RIVER
Practice Address - State:OR
Practice Address - Zip Code:97031-1757
Practice Address - Country:US
Practice Address - Phone:541-436-4547
Practice Address - Fax:833-272-3435
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2598225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR273813Medicaid