Individual provider Active NPI

Cameron Stukel, DPT

  • Physical Therapist
  • Driggs, ID
National Provider Identifier
1104700319
Registry record updated Aug 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7671668 Issued in ID
Practice address
39 W Little Ave
Driggs, ID 83422-5021
Phone
(208) 354-9675
NPI assigned
Aug 1, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 7671668 ID Primary

Addresses

Primary practice location

39 W Little Ave
Driggs, ID 83422-5021

Mailing address

PO Box 342
Tetonia, ID 83452-0342

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20251208001442 WY Practitioner - Physical Therapist in Private Practice 6305339375 Reassigns benefits to 1 organization
I20260603004866 ID Practitioner - Physical Therapist in Private Practice 6305339375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Excel Physical Therapy LLCGroup PAC ID 0345242178, 9 clinicians

Practice addresses (Care Compare)

107 W Little Ave Unit
Suite 2
Driggs, ID 83422-5158
Phone (307) 734-9129

120 W Pearl Ave
Suite F
Jackson, WY 83001-8657
Phone (307) 734-9129

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7671668IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Excel Physical Therapy, LLC Physical Therapist CurrentSince Oct 1, 2025 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1754006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754006400000",
    "number": "1104700319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 342",
            "city": "TETONIA",
            "state": "ID",
            "postal_code": "834520342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 W LITTLE AVE",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225021",
            "telephone_number": "208-354-9675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUKEL",
        "first_name": "CAMERON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-01",
        "last_updated": "2025-08-01",
        "certification_date": "2025-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "7671668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Driggs, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.