Healthcare Provider Details

I. General information

NPI: 1972686087
Provider Name (Legal Business Name): DARRELL EDWIN KRALL PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/27/2024
Certification Date: 01/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 W IRONWOOD CENTER DR
COEUR D ALENE ID
83814-2639
US

IV. Provider business mailing address

2180 W IRONWOOD CENTER DR
COEUR D ALENE ID
83814-2639
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-3680
  • Fax: 208-625-3681
Mailing address:
  • Phone: 208-625-3680
  • Fax: 208-625-3681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00005703
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberPT-468
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-468
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: