Provider Demographics
NPI:1841717683
Name:FOLSOM, DALYNNE (LMT)
Entity type:Individual
Prefix:MISS
First Name:DALYNNE
Middle Name:
Last Name:FOLSOM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 J AVE
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-2073
Mailing Address - Country:US
Mailing Address - Phone:541-963-0339
Mailing Address - Fax:541-663-8882
Practice Address - Street 1:1108 J AVE
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-2073
Practice Address - Country:US
Practice Address - Phone:541-963-0339
Practice Address - Fax:541-663-8882
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR19497225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist