NPIMap

Organization Active NPI

Performance Therapy, LLC

  • Physical Therapist
  • Idaho Falls, ID
National Provider Identifier
1427375724
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-954 Issued in ID
Legal business name
PERFORMANCE THERAPY, LLC
Practice address
3125 Valencia Dr
Idaho Falls, ID 83404-7575
Phone
(208) 529-3332
NPI assigned
Apr 26, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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

Authorized official

Name
Stephanie Liddle, MPTNPI 1942489794
Title
Owner/Manager
Phone
(208) 521-5691

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT-954 ID Primary
Prosthetic/Orthotic Supplier 335E00000X DME14657 ID

Addresses

Primary practice location

3125 Valencia Dr
Idaho Falls, ID 83404-7575

Mailing address

1940 S Bonito Way Ste 190
Meridian, ID 83642-5618
Phone (208) 287-9420

Other practice location 1

2922 Cortez Ave
Idaho Falls, ID 83404-7554
Phone (208) 529-3332

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100701000223 ID Part B Supplier - Clinic/Group Practice 8426189648 Receives reassigned benefits from 4 practitioners
Practice locations: Idaho Falls, ID
O20101027000248 ID DME Supplier - Independently-Practicing Physical Therapist 8426189648 Practice locations: Idaho Falls, ID

National Provider Directory

National Provider Directory

Locations

2922 Cortez Ave
Idaho Falls, ID 83404
Phone (208) 529-3332

3125 Valencia Dr
Idaho Falls, ID 83404
Phone (208) 529-3332

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1272240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1427375724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047575",
            "telephone_number": "208-529-3332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2922 Cortez Ave",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047554",
            "country_code": "US",
            "telephone_number": "208-529-3332",
            "fax_number": "208-529-3336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERFORMANCE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-26",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "LIDDLE",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "208-521-5691",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-954",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "ID",
            "license": "DME14657",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.