Provider Demographics
NPI:1902921083
Name:VITOLINS, VALDA ANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:VALDA
Middle Name:ANN
Last Name:VITOLINS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-9216
Mailing Address - Country:US
Mailing Address - Phone:208-777-9740
Mailing Address - Fax:208-777-8316
Practice Address - Street 1:104 W 9TH AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-9216
Practice Address - Country:US
Practice Address - Phone:208-777-9740
Practice Address - Fax:208-777-8316
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011154225100000X
IDPT-6523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000163115OtherANTHEM
OH062447Medicaid
000000163115OtherANTHEM