Southern Idaho Therapy Services
Organization Active NPI Physical Therapist · Rupert, ID
NPI 1275698490 · NPPES record last updated Nov 2, 2011
Key facts
- NPI
- 1275698490
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- SOUTHERN IDAHO THERAPY SERVICES
- Practice address
- 1224 8TH St Ste a
Rupert, ID 83350-1527 - Phone
- (208) 436-9016
- Fax
- (208) 436-4922
- NPI assigned
- Dec 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Elaine Ford
- Title
- Office Manager
- Phone
- (208) 644-6474
Practitioners 6
-
Jeffery D. Baldwin, P.T.
-
Maria E. Hernandez, P.T.
-
Matthew McKee, PT, DPT
-
Lon Miguel Egbert, PT, ATC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040505001331 | ID | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 5294723326 |
Receives reassigned benefits from 4 practitioners Practice locations: Rupert, ID |
National Provider Directory
Locations
1224 8th St
#A
Rupert, ID 83350
Phone (208) 436-9015
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
1224 8TH St Ste a
Rupert, ID 83350-1527
Mailing address
228 E 100 S
Jerome, ID 83338-6306
Phone (208) 644-6474
Other providers in Rupert, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2011. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.