Hailey Sport and Spine Physical Therapy PA

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1168 Issued in ID

Legal business name

HAILEY SPORT AND SPINE PHYSICAL THERAPY PA

Doing business as

Hailey Sport and Spine

Practice address

810 S Main St
Ste 7a
Hailey, ID 83333-8426

Phone

(208) 788-6312

Fax

(208) 578-1053

NPI assigned

Oct 8, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Kimberly A Mazik, PTNPI 1801884499

Title

Owner

Phone

(208) 788-6312

Specialties & licenses 1

Addresses

Other names 1

• HAILEY SPORT AND SPINE Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Peak Physical Therapy P C

  • Physical Therapist
  • Boise, ID
  • NPI 1073551560

  Member Of

  NPD member

Locations

Practitioners 3

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.

• Kimberly A Mazik, PT

  • Physical Therapist
  • Hailey, ID
  • NPI 1801884499
  NPD (past) Authorized official
• Mary Ellen Oleary, PT

  • Physical Therapist
  • Hailey, ID
  • NPI 1639231459
  NPD (past)
• Kate P Humphrey, PT

  • Physical Therapist
  • Townsend, MT
  • NPI 1609855519
  NPD (past)

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

{
    "created_epoch": "1128729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184612772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1693",
            "address_2": "810 S MAIN ST STE 7A",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833331693",
            "telephone_number": "208-788-6312",
            "fax_number": "208-578-1053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 S MAIN ST",
            "address_2": "STE 7A",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338426",
            "telephone_number": "208-788-6312",
            "fax_number": "208-578-1053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAILEY SPORT AND SPINE PHYSICAL THERAPY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAZIK",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-788-6312",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "1168",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HAILEY SPORT AND SPINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gloria Gould Gunter, MPT, MED, PCS
• Matthew Haas, DMD
• James R Hague, M.D.
• Hailey Chiropractic Clinic PLLC
• Hailey Physcial Therapy, PA
• Lisa Hansen, LMSW
• Kimberly Hayes, LCSW
• Healing Hearts Counseling Services
• Stephanie Herald, LCSW, CADC
• Erin Sensenig Hess

• Physical Therapist in Hailey, ID
• Providers in Hailey, ID by specialty
• 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.