NPIMap

Organization Active NPI

Shellman Inc PA

Doing business as North Idaho Physical Therapy

  • Physical Therapist
  • Coeur d'Alene, ID
National Provider Identifier
1326050253
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
MULTIPLE PROVIDERS Issued in ID
Legal business name
SHELLMAN INC PA
Doing business as
North Idaho Physical Therapy
Practice address
1917 N Lakewood Dr
Coeur D Alene, ID 83814-2634
Phone
(208) 664-8194
Fax
(208) 667-1847
NPI assigned
Aug 12, 2006
Last updated
Mar 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

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

Authorized official

Name
Tess Rogers
Title
Office Manager
Phone
(208) 664-8194

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X MULTIPLE PROVIDERS ID Primary

Addresses

Primary practice location

1917 N Lakewood Dr
Coeur D Alene, ID 83814-2634

Mailing address

1917 N Lakewood Dr
Coeur D Alene, ID 83814-2634
Phone (208) 664-8194

Other identifiers 2

IdentifierTypeStateIssuer
0051780OtherWAGROUP PROVIDER NUMBER
002778800MedicaidID

Other names 1

  • North Idaho Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000340 ID Part B Supplier - Clinic/Group Practice 4981592938 Receives reassigned benefits from 50 practitioners
Practice locations: Coeur D Alene, ID; Spirit Lake, ID; Post Falls, ID; Ponderay, ID; Kellogg, ID; Hayden, ID
O20240116003156 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4981592938 Receives reassigned benefits from 6 practitioners
Practice locations: Liberty Lake, WA

National Provider Directory

National Provider Directory

Locations

940 W Ironwood Dr
Ste A
Coeur D Alene, ID 83814
Phone (208) 625-5311

1172 W Hayden Ave
Hayden, ID 83835
Phone (208) 762-3332

30544 Highway 200
Ste 326
Ponderay, ID 83852
Phone (208) 205-9559

1101 E Polston Ave
#A
Post Falls, ID 83854
Phone (208) 773-8111

1551 E Mullan Ave
Ste 102
Post Falls, ID 83854
Phone (208) 262-2328

750 N Syringa St
Ste 200
Post Falls, ID 83854
Phone (208) 773-8111

2110 N Molter Rd
Ste 113
Liberty Lake, WA 99019
Phone (509) 558-8801

21950 E Country Vista Dr
Ste 200
Liberty Lake, WA 99019
Phone (509) 558-8801

Practitioners & affiliated clinicians

Practitioners 85

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.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1326050253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142634",
            "telephone_number": "208-664-8194",
            "fax_number": "208-667-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1917 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142634",
            "telephone_number": "208-664-8194",
            "fax_number": "208-667-1847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELLMAN INC PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "TESS",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-664-8194"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "MULTIPLE PROVIDERS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PROVIDER NUMBER",
            "identifier": "0051780",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002778800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Idaho Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur d'Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.