NPIMap

Organization Active NPI

Lakeland Physical Therapy and Sports Injuries P a

Doing business as North Idaho Physical Therapy

  • Physical Therapist
  • Rathdrum, ID
National Provider Identifier
1083896674
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LAKELAND PHYSICAL THERAPY AND SPORTS INJURIES P A
Doing business as
North Idaho Physical Therapy
Practice address
16658 N Highway 41
Rathdrum, ID 83858-6890
Phone
(208) 687-9195
Fax
(844) 955-2492
NPI assigned
Dec 5, 2007
Last updated
Apr 30, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Sky R Pruitt, PTNPI 1164749974
Title
Physical Therapist/Owner
Phone
(208) 687-9195

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X ID Primary

Addresses

Primary practice location

16658 N Highway 41
Rathdrum, ID 83858-6890

Mailing address

16658 N Highway 41
Rathdrum, ID 83858-6890
Phone (208) 687-9195

Other identifiers 2

IdentifierTypeStateIssuer
2803500MedicaidID
002803500MedicaidID

Other names 1

  • North Idaho Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040511001525 ID Part B Supplier - Clinic/Group Practice 9537158787 Receives reassigned benefits from 5 practitioners
Practice locations: Rathdrum, ID

National Provider Directory

National Provider Directory

Locations

16658 N Highway 41
Rathdrum, ID 83858
Phone (208) 687-9195

16768 N Highway 41
Rathdrum, ID 83858
Phone (208) 687-9195

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1196812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1083896674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16658 N HIGHWAY 41",
            "city": "RATHDRUM",
            "state": "ID",
            "postal_code": "838586890",
            "telephone_number": "208-687-9195",
            "fax_number": "844-955-2492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16658 N HIGHWAY 41",
            "city": "RATHDRUM",
            "state": "ID",
            "postal_code": "838586890",
            "telephone_number": "208-687-9195",
            "fax_number": "844-955-2492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND PHYSICAL THERAPY AND SPORTS INJURIES P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-05",
        "last_updated": "2025-04-30",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "SKY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "208-687-9195",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2803500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002803500",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Idaho Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rathdrum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.