Provider Demographics
NPI:1821973231
Name:DISTANT, DARILYN DEBRA (DPT PT)
Entity type:Individual
Prefix:
First Name:DARILYN
Middle Name:DEBRA
Last Name:DISTANT
Suffix:
Gender:F
Credentials:DPT PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12465 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-4064
Mailing Address - Country:US
Mailing Address - Phone:971-732-9864
Mailing Address - Fax:
Practice Address - Street 1:855 SW YATES DR STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3217
Practice Address - Country:US
Practice Address - Phone:971-732-9864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics