Individual provider Active NPI

Julie A Ellis, PT

  • Physical Therapist
  • Twin Falls, ID
National Provider Identifier
1205999281
Registry record updated Apr 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
RPT-267 Issued in ID
Practice address
754 N College Rd
Ste D
Twin Falls, ID 83301-5822
Phone
(208) 734-5313
Fax
(208) 736-1582
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X RPT-267 ID Primary

Addresses

Primary practice location

754 N College Rd
Ste D
Twin Falls, ID 83301-5822

Mailing address

754 N College Rd
Ste D
Twin Falls, ID 83301-5822
Phone (208) 734-5313

Other identifiers 1

IdentifierTypeStateIssuer
002620200MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070801000614 ID Practitioner - Physical Therapist in Private Practice 6608842760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Center for Physical Rehabilitation, LLCGroup PAC ID 6002882164, 14 clinicians

Practice addresses (Care Compare)

754 N College Rd
Suite D
Twin Falls, ID 83301-5822
Phone (208) 734-5313

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RPT-267IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Center for Physical Rehabilitation, LLC Physical Therapist CurrentSince Jun 1, 2007 Accepting new patients

Locations

1015 Main St
Buhl, ID 83316
Phone (208) 543-8887

754 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 731-5313

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303344000000",
    "number": "1205999281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "754 N COLLEGE RD",
            "address_2": "STE D",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015822",
            "telephone_number": "208-734-5313",
            "fax_number": "208-736-1582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "754 N COLLEGE RD",
            "address_2": "STE D",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015822",
            "telephone_number": "208-734-5313",
            "fax_number": "208-736-1582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "JULIE",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2011-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "RPT-267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002620200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.