Advanced Physical Therapy & Wound Center, PLLC
Organization Active NPI Physical Therapist · Rexburg, ID
NPI 1356754147 · NPPES record last updated Jun 11, 2015
Key facts
- NPI
- 1356754147
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- ADVANCED PHYSICAL THERAPY & WOUND CENTER, PLLC
- Practice address
- 1 Professional PLZ
Rexburg, ID 83440-2024 - Phone
- (208) 359-2500
- Fax
- (208) 359-2502
- NPI assigned
- Jun 9, 2014
- Organization subpart
- No
Authorized official
- Name
- Mrs. Alicia Siddoway, P.T.
- Title
- Director of Therapy
- Phone
- (208) 359-2500
Practitioners 9
-
Jakob Carstens, DPT
-
Cade Steven Kelley, DPT
-
Ellen Rae Mackinnon, CNS-NP
-
Kristi Neibaur, D.P.T.
-
Alicia G Siddoway, RPT
-
Matthew Hardy Allred, D.O.
-
Fay Coleman Ashment, APPN-NP
-
Edward E Evans, MD
-
Toni Frahm, CNM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141104002506 | ID | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 2567684640 |
Receives reassigned benefits from 5 practitioners Practice locations: Rexburg, ID |
National Provider Directory
Locations
1 Professional Plz
Rexburg, ID 83440
Phone (208) 356-9231
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant |
224Z00000X | |||
| Physical Therapist |
225100000X | Yes | ||
| Physical Therapy Assistant |
225200000X | |||
| Occupational Therapist |
225X00000X | |||
| Audiologist |
231H00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
1 Professional PLZ
Rexburg, ID 83440-2024
Mailing address
PO Box 322
Rexburg, ID 83440-0322
Phone (208) 359-2500
Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 11, 2015. 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.