NPIMap

Organization Active NPI

Jump Start Pediatric Therapy, LLC

  • Physical Therapy Clinic/Center
  • Coeur d'Alene, ID
National Provider Identifier
1144494105
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT-2061 Issued in ID
Legal business name
JUMP START PEDIATRIC THERAPY, LLC
Practice address
411 W Haycraft Ave
Ste B3
Coeur D Alene, ID 83815-8105
Phone
(208) 664-2468
Fax
(208) 667-6239
NPI assigned
Apr 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

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

Authorized official

Name
Mrs. Ellison Sanders, PT
Title
Owner / Physical Therapist
Phone
(208) 664-2468

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X PT-2061 ID Primary

Addresses

Primary practice location

411 W Haycraft Ave
Ste B3
Coeur D Alene, ID 83815-8105

Mailing address

411 W Haycraft Ave
Ste B3
Coeur D Alene, ID 83815-8105
Phone (208) 664-2468

Other identifiers 3

IdentifierTypeStateIssuer
807908300MedicaidID
000010164610OtherREGENCE BLUE SHIELD
TD687OtherBLUE CROSS OF IDAHO

National Provider Directory

National Provider Directory

Locations

411 W Haycraft Ave
Ste B3
Coeur D Alene, ID 83815
Phone (208) 664-2468

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1144494105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 W HAYCRAFT AVE",
            "address_2": "STE B3",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158105",
            "telephone_number": "208-664-2468",
            "fax_number": "208-667-6239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 W HAYCRAFT AVE",
            "address_2": "STE B3",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158105",
            "telephone_number": "208-664-2468",
            "fax_number": "208-667-6239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUMP START PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-21",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "SANDERS",
        "authorized_official_first_name": "ELLISON",
        "authorized_official_title_or_position": "OWNER / PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-664-2468",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ID",
            "license": "PT-2061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807908300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "000010164610",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IDAHO",
            "identifier": "TD687",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2012; 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.