Janeil M Heaton, M.P.T.
Individual provider Active NPI Specialist · Fruitland, ID
NPI 1245205665 · NPPES record last updated Jul 1, 2010
Key facts
- NPI
- 1245205665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- PT1882 (ID)
- Practice address
- 215 N Whitley Dr
Suite 1
Fruitland, ID 83619-2705 - Phone
- (208) 452-6366
- Fax
- (208) 452-6399
- NPI assigned
- Feb 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- In Motion Physical Therapy LLC
Practice addresses (Care Compare)
501 Ctr St
Rock Springs, WY 82901-5105
Phone (307) 382-8661
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in ID, WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040902001435 | ID | Practitioner - Physical Therapist in Private Practice | 8820064660 | Reassigns benefits to 1 organization |
| I20210212002178 | WY | Practitioner - Physical Therapist in Private Practice | 8820064660 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT1882 | ID | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-City Physical Therapy, P.C. | Specialist | Current |
Accepting new patients |
| Tri-City Physical Therapy, P.C. | Specialist | Current |
Accepting new patients |
| In Motion Physical Therapy LLC | Current |
Accepting new patients |
Locations
215 N Whitley Dr
Ste 1
Fruitland, ID 83619
Phone (208) 452-6366
275 E 7th St
Weiser, ID 83672
Phone (208) 549-1008
501 Center St
Rock Springs, WY 82901
Phone (307) 382-8661
617 Broadway St
Ste C
Rock Springs, WY 82901
Phone (307) 382-8661
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT1882 | ID | Yes |
Addresses
Primary practice location
215 N Whitley Dr
Suite 1
Fruitland, ID 83619-2705
Mailing address
215 N Whitley Dr
Suite 1
Fruitland, ID 83619-2705
Phone (208) 452-6366
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806985500 | Medicaid | ID |
Other providers in Fruitland, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 1, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.