Individual
MR. DARYL L. IVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
3584
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-3708203
HEALTHNET
OR
01
—
113708203
LIFEWISE
OR
01
—
500113701
BLUE CROSS - ACCESS BLUE
OR
01
—
831552000
BLUE CROSS PPP
OR
01
—
J 2333-01
PACIFICSOURCE
OR
Enumeration date
12/08/2006
Last updated
07/09/2007
Update your record
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