Provider Demographics
NPI:1376356899
Name:BILLINGSLEY, TRISTA (PTA)
Entity type:Individual
Prefix:
First Name:TRISTA
Middle Name:
Last Name:BILLINGSLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 E ESQUEL ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-4891
Mailing Address - Country:US
Mailing Address - Phone:559-999-7067
Mailing Address - Fax:
Practice Address - Street 1:943 N LINDER RD
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-3394
Practice Address - Country:US
Practice Address - Phone:559-999-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6671145225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant