NPIMap

Organization Active NPI

Ellis Physical Therapy P a

  • Physical Therapist
  • Idaho Falls, ID
National Provider Identifier
1518203249
Registry record updated Apr 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ELLIS PHYSICAL THERAPY P A
Practice address
3100 S Woodruff Ave
Idaho Falls, ID 83404-8310
Phone
(208) 523-8879
Fax
(208) 523-0436
NPI assigned
Dec 28, 2012
Last updated
Apr 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2018

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

Authorized official

Name
Terri L Larsen
Title
Office Manager
Phone
(208) 523-8879

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

3100 S Woodruff Ave
Idaho Falls, ID 83404-8310

Mailing address

PO Box 1463
Idaho Falls, ID 83403-1463
Phone (208) 523-8879

Other identifiers 1

IdentifierTypeStateIssuer
804274500MedicaidID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524182400000",
    "number": "1518203249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1463",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834031463",
            "telephone_number": "208-523-8879",
            "fax_number": "208-523-0436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834048310",
            "telephone_number": "208-523-8879",
            "fax_number": "208-523-0436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLIS PHYSICAL THERAPY P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-28",
        "last_updated": "2018-04-20",
        "status": "A",
        "authorized_official_last_name": "LARSEN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-523-8879"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804274500",
            "state": "ID"
        }
    ],
    "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 Apr 20, 2018; 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.