Individual
MR. DARYL L. IVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
4132 DEVONSHIRE CT NE, SALEM, OR 97305-1982
(503) 371-4800
(503) 371-4801
Mailing address
4132 DEVONSHIRE CT NE, SALEM, OR 97305-1982
(503) 371-4800
(503) 371-4801
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
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