Healthcare Provider Details

I. General information

NPI: 1902921083
Provider Name (Legal Business Name): VALDA ANN VITOLINS MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 3RD ST
COEUR D ALENE ID
83814-2861
US

IV. Provider business mailing address

301 N 3RD ST
COEUR D ALENE ID
83814-2861
US

V. Phone/Fax

Practice location:
  • Phone: 208-215-2210
  • Fax:
Mailing address:
  • Phone: 208-215-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-6523
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: