Physical Therapy and Sports Medicine Clinic Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

T 236 Issued in ID

Legal business name

PHYSICAL THERAPY AND SPORTS MEDICINE CLINIC INC

Practice address

4102 E 82 N
Rigby, ID 83442-5894

Phone

(208) 745-8580

Fax

(208) 745-8580

NPI assigned

Dec 12, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Laura B Jenkins

Title

Secretary

Phone

(208) 745-8580

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221436800000",
    "number": "1568645554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 E 82 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425894",
            "telephone_number": "208-745-8580",
            "fax_number": "208-745-8580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4102 E 82 N",
            "city": "RIGBY",
            "state": "ID",
            "postal_code": "834425894",
            "telephone_number": "208-745-8580",
            "fax_number": "208-745-8580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY AND SPORTS MEDICINE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-12",
        "last_updated": "2008-09-15",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-745-8580",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "T 236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002591700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806469200",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsay Owen, DPT
• Palisade Physical Therapy & Wellness Services
• Park Avenue Counseling Services, LLC
• Pathways to Success
• Mark L Peterson, DDS
• Pick PT Physical Therapy Rigby
• Ashlee Danielle Pierce, LPN
• Garret Portela
• Nathan R Porter, LCSW
• Paige Celeste Poston

• Physical Therapist in Rigby, ID
• Providers in Rigby, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; 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.