Andreasen Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-737 Issued in ID

Legal business name

ANDREASEN PHYSICAL THERAPY PC

Practice address

1808 N 2190 E
Sugar City, ID 83448-1310

Phone

(208) 201-0877

NPI assigned

Jan 18, 2007

Organization subpart

No

Name

Mr. Dirk Andreasen, PT

Title

President

Phone

(208) 201-0877

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104979855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 N 2190 E",
            "city": "SUGAR CITY",
            "state": "ID",
            "postal_code": "834481310",
            "telephone_number": "208-201-0877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 N 2190 E",
            "city": "SUGAR CITY",
            "state": "ID",
            "postal_code": "834481310",
            "telephone_number": "208-201-0877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANDREASEN PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDREASEN",
        "authorized_official_first_name": "DIRK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-201-0877",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD NUMBER",
            "identifier": "327268",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "T3761",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Arnold, LCSW
• Mekayla Bishop, LMSW
• Ellon Chase, LPC
• Thane Hepworth, DDS
• Tonya Hollist, LCSW

• All providers in Sugar City, ID
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.