NPIMap

Organization Active NPI

Pro-Active Physical Therapy of McCall, PA

  • Physical Therapist
  • McCall, ID
National Provider Identifier
1295847242
Registry record updated Mar 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRO-ACTIVE PHYSICAL THERAPY OF MCCALL, PA
Practice address
319 Deinhard LN
McCall, ID 83638-4703
Phone
(208) 634-8517
Fax
(208) 292-2817
NPI assigned
Aug 31, 2006
Last updated
Mar 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2020

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

Authorized official

Name
Patrick J Zak, RPTNPI 1649341967
Title
Ceo/Owner
Phone
(208) 634-8517

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

319 Deinhard LN
McCall, ID 83638-4703

Mailing address

P.O. Box 2041
McCall, ID 83638
Phone (208) 634-8517

Other practice location 1

409 S. Third Street,
Suite C
McCall, ID 83638
Phone (208) 634-8517

Other identifiers 2

IdentifierTypeStateIssuer
805164900MedicaidID
808054300MedicaidID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100618000370 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7719986827 Receives reassigned benefits from 3 practitioners
Practice locations: McCall, ID

National Provider Directory

National Provider Directory
Tax ID family
Pro-Active Physical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

409 S 3rd St
Ste C
McCall, ID 83638
Phone (208) 634-8517

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1295847242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2041",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "83638",
            "telephone_number": "208-634-8517",
            "fax_number": "208-634-5763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 DEINHARD LN",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836384703",
            "telephone_number": "208-634-8517",
            "fax_number": "208-292-2817"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "409 S. Third Street,",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "McCall",
            "state": "ID",
            "postal_code": "83638",
            "country_code": "US",
            "telephone_number": "208-634-8517",
            "fax_number": "208-634-5763",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRO-ACTIVE PHYSICAL THERAPY OF MCCALL, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "ZAK",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "208-634-8517",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805164900",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808054300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in McCall, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; 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.