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General NPI Number Information
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NPI Number | 1447324116
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Entity Type | Individual
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Provider Name | DANNY RAE DESFOSSES DPT
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Gender | Male
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 1033 W QUINN RD
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City | POCATELLO
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State | ID
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Zip | 83202-2425
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Country | US
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Telephone | 208-233-4800
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Fax | 208-233-4887
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Provider Business Mailing Address
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Address Line | PO BOX 2844
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City | POCATELLO
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State | ID
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Zip | 83206-2844
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Country | US
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Telephone | 208-233-4800
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Fax | 208-233-4887
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT060
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License Number State | ID
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