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General NPI Number Information
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NPI Number | 1376356899
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Entity Type | Individual
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Provider Name | TRISTA BILLINGSLEY PTA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 943 N LINDER RD
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City | KUNA
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State | ID
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Zip | 83634-3394
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Country | US
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Telephone | 559-999-7067
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 E ESQUEL ST
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City | KUNA
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State | ID
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Zip | 83634-4891
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Country | US
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Telephone | 559-999-7067
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 6671145
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License Number State | ID
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