Organization
KISMET PC
Active
Other names
Stafford Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
DAREN A STAFFORD DPT (OWNER/PROVIDER)
(208) 991-8487
Entity
Organization
Contact information
Practice address
280 E JACKSON ST, MOUNTAIN HOME, ID 83647
(208) 991-8487
Mailing address
280 E JACKSON ST, MOUNTAIN HOME, ID 83647-2708
(208) 991-8487
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
PT-2466
ID
Other
Enumeration date
07/31/2017
Last updated
07/21/2022
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