Jessica Annelaine Vandyke, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-5957 Issued in ID

Practice address

282 W Bridge St
Blackfoot, ID 83221

Phone

(208) 684-0021

NPI assigned

Nov 2, 2018

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

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Prime Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Blackfoot, ID
  • NPI 1851051718

  Physical Therapist

  Medicare reassignment NPD Authorized official
• Barnes Physical Therapy, LLC

  • Physical Therapist
  • Blackfoot, ID
  • NPI 1548524440
  Medicare reassignment NPD
• McDonald Rehab, PC

  • Physical Therapist
  • Pocatello, ID
  • NPI 1497948509
  Medicare reassignment NPD

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

{
    "created_epoch": "1541116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663286400000",
    "number": "1104394659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248",
            "fax_number": "208-233-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "282 W BRIDGE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "83221",
            "telephone_number": "208-684-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDYKE",
        "first_name": "JESSICA",
        "middle_name": "ANNELAINE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-02",
        "last_updated": "2022-09-16",
        "certification_date": "2022-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-5957",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Michael Ullery, D.O.
• United Family Services, LLC
• University of Utah Pediatric Services
• Untangled Counseling, PLLC
• Valley Medical Shoppe Inc
• Camille Vanorden
• Austin Wadsworth
• Wal-Mart Stores, Inc
• Walgreen Co
• Ruby Lee Walker, LPCP

• Physical Therapist in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2022; 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.