PT Medical LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

PT MEDICAL LLC

Practice address

490 Memorial Dr
Idaho Falls, ID 83402-3656

Phone

(630) 364-8144

Fax

(866) 661-4322

NPI assigned

Apr 17, 2013

Organization subpart

No

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

Authorized official

Name

Stephen Bird

Title

Managing Member

Phone

(630) 364-8144

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1366156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366156800000",
    "number": "1073956306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 51630",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834051630",
            "telephone_number": "630-364-8144",
            "fax_number": "866-661-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 MEMORIAL DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834023656",
            "telephone_number": "630-364-8144",
            "fax_number": "866-661-4322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-17",
        "last_updated": "2013-04-17",
        "status": "A",
        "authorized_official_last_name": "BIRD",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "630-364-8144"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.