NPIMap

Organization Active NPI

Scott Randklev Physical Therapy P.a.

  • Physical Therapist
  • Coeur D Alene, ID
National Provider Identifier
1437744752
Registry record updated Mar 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SCOTT RANDKLEV PHYSICAL THERAPY P.A.
Practice address
370 E Kathleen Ave Ste 500
Coeur D Alene, ID 83815-5238
Phone
(208) 292-1372
Fax
(208) 292-1374
NPI assigned
Mar 8, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2021

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

Authorized official

Name
Dr. Scott Randklev, DPTNPI 1568756716
Title
President
Phone
(208) 431-0268

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: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary
Orthopedic Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2251X0800X

Addresses

Primary practice location

370 E Kathleen Ave Ste 500
Coeur D Alene, ID 83815-5238

Mailing address

1296 S Fairmont Loop
Coeur D Alene, ID 83814-8932
Phone (208) 431-0268

Other names 1

  • Lifestyle Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210727001760 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9537562699 Receives reassigned benefits from 5 practitioners
Practice locations: Coeur D Alene, ID

National Provider Directory

National Provider Directory

Locations

370 E Kathleen Ave
Ste 500
Coeur D Alene, ID 83815
Phone (208) 292-1372

Practitioners & affiliated clinicians

Practitioners 7

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": "1615161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615161600000",
    "number": "1437744752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1296 S FAIRMONT LOOP",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838148932",
            "telephone_number": "208-431-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 E KATHLEEN AVE STE 500",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838155238",
            "telephone_number": "208-292-1372",
            "fax_number": "208-292-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTT RANDKLEV PHYSICAL THERAPY P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-08",
        "last_updated": "2021-03-08",
        "certification_date": "2021-03-08",
        "status": "A",
        "authorized_official_last_name": "RANDKLEV",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-431-0268",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifestyle 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 8, 2021; 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.