Basic Information
| Provider Information | |||||||||
| NPI: | 1861965246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STARKEY | ||||||||
| FirstName: | TORIN | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1590 E POLSTON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087774242 | ||||||||
| FaxNumber: | 2087774020 | ||||||||
| Practice Location | |||||||||
| Address1: | 1590 E POLSTON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087774242 | ||||||||
| FaxNumber: | 2087774020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2019 | ||||||||
| LastUpdateDate: | 01/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA-3751 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
ID Information
| ID | Type | State | Issuer | Description | PTA-3751 | 01 | ID | STATE OF IDAHO BOARD OF OCCUPATIONAL LICENCES | OTHER |