Healthcare Provider Details

I. General information

NPI: 1861965246
Provider Name (Legal Business Name): TORIN EDWARD STARKEY PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 N NORTHWOOD CENTER CT STE B
COEUR D ALENE ID
83814-4944
US

IV. Provider business mailing address

1321 N NORTHWOOD CENTER CT STE B
COEUR D ALENE ID
83814-4944
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-7055
  • Fax: 208-665-7093
Mailing address:
  • Phone: 206-665-7055
  • Fax: 208-665-7093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA-3751
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: