Active NPI
Elaine J Spang, PTA
- Physical Therapy Assistant
- Driggs, ID
National Provider Identifier
1487862876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA222
- Practice address
- 50 Ski Hill Rd
Driggs, ID 83422 - Phone
- (208) 354-3128
- Fax
- (208) 354-3128
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA222 | ID | Primary |
Addresses
Primary practice location
50 Ski Hill Rd
Driggs, ID 83422
Mailing address
PO Box 1612
Idaho Falls, ID 83403-1612
Phone (208) 525-2090
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA222 | ID | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| High Peaks Physical Therapy P a | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Driggs, ID
- NPI 1356412837
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1487862876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1612",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834031612",
"telephone_number": "208-525-2090",
"fax_number": "208-525-2662"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 SKI HILL RD",
"city": "DRIGGS",
"state": "ID",
"postal_code": "83422",
"telephone_number": "208-354-3128",
"fax_number": "208-354-3128"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPANG",
"first_name": "ELAINE",
"middle_name": "J",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Driggs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.