| Daniel Stark Russon, DPT, PT | |
|
931 Center St W Ste C, Kimberly, ID 83341-5326 | |
| (208) 423-9999 | |
| (208) 423-9998 |
| Full Name | Daniel Stark Russon |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 931 Center St W Ste C, Kimberly, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962242669 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT-9150 (Idaho) | Primary |
| Provider Name | Mcdonald Rehab Pc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1497948509 PECOS PAC ID: 2163505603 Enrollment ID: O20080207000254 |
| Mailing Address | Practice Location Address |
|---|---|
| Daniel Stark Russon, DPT, PT 1411 Falls Ave E Ste 401, Twin Falls, ID 83301-3455 Ph: (208) 423-9999 | Daniel Stark Russon, DPT, PT 931 Center St W Ste C, Kimberly, ID 83341-5326 Ph: (208) 423-9999 |
Reagan Ronald Ward, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 931 Center St W Ste C, Kimberly, ID 83341 Phone: 208-423-9999 Fax: 208-423-9998 | |
Trevor Baker Physical Therapy Physical Therapist Medicare: Medicare Enrolled Practice Location: 3463 E 3890 N, Kimberly, ID 83341 Phone: 208-644-0693 | |
Ashlyn Marie Zoon, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 931 Center St W Ste C, Kimberly, ID 83341 Phone: 208-423-9999 Fax: 208-423-9998 | |
Ammon Benjamin Birk, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 940 Ballard Way, Kimberly, ID 83341 Phone: 801-874-0479 | |
Dr. Trevor John Baker, PT, DPT, GCS Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 3463 E 3890 N, Kimberly, ID 83341 Phone: 208-644-0693 Fax: 208-231-8628 |