Individual provider Active NPI

Brittany Roberts, PTA

  • Physical Therapy Assistant
  • Burley, ID
National Provider Identifier
1457896508
Registry record updated Dec 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
3528 Issued in ID
Practice address
2303 Parke Avenue
Burley, ID 83318
Phone
(208) 677-3073
Fax
(208) 677-3181
NPI assigned
Dec 28, 2016
Last updated
Dec 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 3528 ID Primary

Addresses

Primary practice location

2303 Parke Avenue
Burley, ID 83318

Mailing address

225 Falls Ave W
Apt 214
Twin Falls, ID 83301-2600
Phone (208) 869-1020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482883200000",
    "number": "1457896508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 FALLS AVE W",
            "address_2": "APT 214",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833012600",
            "telephone_number": "208-869-1020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2303 PARKE AVENUE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "83318",
            "telephone_number": "208-677-3073",
            "fax_number": "208-677-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "BRITTANY",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-28",
        "last_updated": "2016-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "3528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burley, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.