Active NPI
Amanda Draper
- Physical Therapy Assistant
- Nampa, ID
National Provider Identifier
1205258316
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA-3287
- Practice address
- 5911 Joe LN
Nampa, ID 83687-8703 - Phone
- (208) 412-0002
- NPI assigned
- Jan 8, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA-3287 | ID | Primary |
Addresses
Primary practice location
5911 Joe LN
Nampa, ID 83687-8703
Mailing address
5911 Joe LN
Nampa, ID 83687-8703
Phone (208) 412-0002
Other names 1
- Amanda Mary Wilson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-3287 | ID | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1205258316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5911 JOE LN",
"city": "NAMPA",
"state": "ID",
"postal_code": "836878703",
"telephone_number": "208-412-0002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5911 JOE LN",
"city": "NAMPA",
"state": "ID",
"postal_code": "836878703",
"telephone_number": "208-412-0002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DRAPER",
"first_name": "AMANDA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-01-08",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA-3287",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "WILSON",
"middle_name": "MARY",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.