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General NPI Number Information
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NPI Number | 1902511801
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Entity Type | Individual
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Provider Name | DARLA KAY VILLOPOTO LMT
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Gender | Female
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 3510 12TH ST STE 200
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City | LEWISTON
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State | ID
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Zip | 83501-5575
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Country | US
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Telephone | 208-799-3333
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Fax |
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Provider Business Mailing Address
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Address Line | 1218 1/2 PROSPECT AVE
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City | LEWISTON
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State | ID
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Zip | 83501-2241
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Country | US
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Telephone | 208-790-7124
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MAS-4791
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License Number State | ID
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