Proactive Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1299 Issued in ID

Legal business name

PROACTIVE PHYSICAL THERAPY PC

Practice address

2311 Park Ave
Suite 2
Burley, ID 83318-2170

Phone

(208) 677-2489

Fax

(208) 677-4023

NPI assigned

Apr 20, 2007

Organization subpart

No

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

Authorized official

Name

Raulan Young, MPTNPI 1700954161

Title

President

Phone

(208) 677-2489

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 4

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.

• Raulan Young, MPT

  • Physical Therapist
  • Burley, ID
  • NPI 1700954161
  Medicare reassignment NPD Authorized official
• Jeff Gibbons, PT, DPT

  • Physical Therapist
  • Burley, ID
  • NPI 1821166281
  NPD (past)
• Tara Osborne

  • Physical Therapist
  • McCall, ID
  • NPI 1477843811
  NPD (past)
• James Leroy Anderson, MPT

  • Physical Therapist
  • Omaha, NE
  • NPI 1437110137
  NPD (past)

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1609093434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 PARK AVE",
            "address_2": "SUITE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182170",
            "telephone_number": "208-677-2489",
            "fax_number": "208-677-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2311 PARK AVE",
            "address_2": "SUITE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182170",
            "telephone_number": "208-677-2489",
            "fax_number": "208-677-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "RAULAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-677-2489",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805407300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premise Health of Colorado Medical PC (Dot Burley Family Health Center)
• Jennifer Lee Primrose, LPC
• Alberta Sue Prince
• Pro Active Advantage, LLC (Pro Active Behavioral Health)
• Pro Active Advantage, LLC (Pro Active Behavioral Health)
• Professional Anesthesia Services
• Michelle S Pufahl, PHARM D
• R Bret Campbell DO & Assoc LLC
• Jennifer Raae-Nielsen, MD
• Henry Rainbolt III, PA-C

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; 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.