Pro Ortho Physical Therapy PLLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT1003 Issued in ID

Legal business name

PRO ORTHO PHYSICAL THERAPY PLLC

Doing business as

Adavanced Performance Physical Therapy Associates

Practice address

2240 E Center St
Pocatello, ID 83201-2600

Phone

(208) 478-6780

Fax

(208) 478-0194

NPI assigned

Aug 18, 2017

Organization subpart

No

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

Authorized official

Name

Robert Lance Marshall, DPTNPI 1376688648

Title

Owner

Phone

(208) 478-6780

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• Adavanced Performance Physical Therapy Associates Doing business as
• Advanced Performance Physical Theraphy Associates PLLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

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

• Robert Lance Marshall, PT, DPT, MS

  • Physical Therapist
  • Pocatello, ID
  • NPI 1376688648
  Medicare reassignment Care Compare group NPD Authorized official
• Jordan Scott Anderson, DPT

  • Physical Therapist
  • Pocatello, ID
  • NPI 1932510690
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1194241380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-478-6780",
            "fax_number": "208-478-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 E CENTER ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832012600",
            "telephone_number": "208-478-6780",
            "fax_number": "208-478-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO ORTHO PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LANCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-478-6780",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "ID",
            "license": "PT1003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194241380",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adavanced Performance Physical Therapy Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Performance Physical Theraphy Associates PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kara Jepkorir Price
• Seth Priebe
• Primary Care Specialists, PA
• Edward J Prince
• Prism Family Medicine LLC
• Proactive Living, LLC
• Steven D Proctor, LCSW
• Prohealth
• Prohealth
• Prohealth Home Care Services, Inc.

• Orthopedic Physical Therapist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Orthopedic Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.