Provider Demographics
NPI:1932366325
Name:DARST, LISA JOANN (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JOANN
Last Name:DARST
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 6
Mailing Address - Street 2:
Mailing Address - City:KELLOGG
Mailing Address - State:ID
Mailing Address - Zip Code:83837
Mailing Address - Country:US
Mailing Address - Phone:208-661-9180
Mailing Address - Fax:208-682-2735
Practice Address - Street 1:601 W CAMERON AVE
Practice Address - Street 2:MOUNTAIN VALLEY CARE & REHABILITATION CENTER
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2004
Practice Address - Country:US
Practice Address - Phone:208-784-1283
Practice Address - Fax:208-784-0151
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist