Tiffany Heather Maxwell, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA5326 Issued in ID

Practice address

2037 E 17TH St
Idaho Falls, ID 83404-6430

Phone

(208) 529-3355

Fax

(208) 529-9581

NPI assigned

Apr 24, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Tiffany Heather Packer Former name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teton Physical Therapy, Inc

  • Orthopedic Physical Therapist
  • Idaho Falls, ID
  • NPI 1053633313
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759104000000",
    "number": "1063268753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2037 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046430",
            "telephone_number": "208-529-3355",
            "fax_number": "208-529-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2037 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046430",
            "telephone_number": "208-529-3355",
            "fax_number": "208-529-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "TIFFANY",
        "middle_name": "HEATHER",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-24",
        "last_updated": "2025-09-29",
        "certification_date": "2025-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA5326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROFESSIONAL LICENSE",
            "identifier": "PTA5326",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIFFANY",
            "last_name": "PACKER",
            "middle_name": "HEATHER",
            "prefix": "MS.",
            "credential": "PTA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Bodell H Maughan, PHARMD
• Eric B Maughan, MD
• Heidi Rudd Maurer, LPC
• Maxfield Anesthesia
• Brett Buckley Maxfield, RN
• Aaron Ashton May, OTR
• Brooke Kaylene May
• William James May, LMFT
• Harrison Anderson Mayes
• Patrick Terry Mayo, DC

• Physical Therapy Assistant in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.