Elite Sports and Orthopedic Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

ELITE SPORTS AND ORTHOPEDIC PHYSICAL THERAPY LLC

Practice address

3896 N Schreiber Way
Coeur D Alene, ID 83815-8362

Phone

(208) 969-1554

Fax

(208) 475-7708

NPI assigned

Apr 12, 2017

Last updated

May 25, 2023By 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

Ryan Bishop, DPTNPI 1861649741

Title

Ceo

Phone

(208) 969-1554

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

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.

• Ryan Jacob Bishop, DPT

  • Physical Therapist
  • Coeur d'Alene, ID
  • NPI 1861649741
  Medicare reassignment NPD Authorized official
• Anna Rose Owens, PTA

  • Physical Therapy Assistant
  • Coeur d'Alene, ID
  • NPI 1548076417
  NPD
• Kala Marie Moore, LMP

  • Specialist
  • Coeur d'Alene, ID
  • NPI 1619278082
  NPD (past)

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684972800000",
    "number": "1215461793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3896 N SCHREIBER WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158362",
            "telephone_number": "208-666-6665",
            "fax_number": "208-475-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3896 N SCHREIBER WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838158362",
            "telephone_number": "208-969-1554",
            "fax_number": "208-475-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE SPORTS AND ORTHOPEDIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-12",
        "last_updated": "2023-05-25",
        "certification_date": "2023-05-25",
        "status": "A",
        "authorized_official_last_name": "BISHOP",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "208-969-1554",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Eldridge
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• Leanne Elisha, PMHNP
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• Ellenbecker Eye Clinic, PLLC
• Cindy L Ellenbecker, OD
• Wayne D Ellenbecker, O.D.
• Brenda G Elliff, RN
• Shawna Elliott

• Physical Therapy Clinic/Center in Coeur d'Alene, ID
• Providers in Coeur d'Alene, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2023; 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.