Desfosses, Danny Rae

Desfosses, Danny Rae is an individual health care provider with primary practice located at 1033 W Quinn Rd , Pocatello ID 83202-2425. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Desfosses, Danny Rae can be contacted via phone (208) 233-4800.

Contact Information

Primary practice address
1033 W Quinn Rd Pocatello ID 83202-2425
Phone: (208) 233-4800
Fax: (208) 233-4887
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT060 Idaho

Profile Details

NPI number 1447324116
LBN Legal business name Desfosses, Danny Rae
Credentials DPT
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2006
Last updated Dec 21st, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1447324116 NPPES
Idaho Other 000010008720 BLUE SHIELD
Idaho MEDICAID 004399000 BLUE SHIELD
Idaho Other T1559 BLUE SHIELD
Idaho Other 650008819 BLUE SHIELD

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