NPIMap

Organization Active NPI

Sun Valley Sports Rehabilitation

  • Sports Physical Therapist
  • Ketchum, ID
National Provider Identifier
1639229115
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
PT-332 Issued in ID
Legal business name
SUN VALLEY SPORTS REHABILITATION
Practice address
245 Raven Rd
Ketchum, ID 83340
Phone
(208) 726-7246
Fax
(208) 726-8911
NPI assigned
Jan 10, 2007
Last updated
Jun 26, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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

Authorized official

Name
Colleen CoyneNPI 1780779280
Title
President, Owner
Phone
(208) 726-7246

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251S0007X PT-332 ID Primary

Addresses

Primary practice location

245 Raven Rd
Ketchum, ID 83340

Mailing address

PO Box 2062
Ketchum, ID 83340-2062
Phone (208) 726-7246

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340668800000",
    "number": "1639229115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2062",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833402062",
            "telephone_number": "208-726-7246",
            "fax_number": "208-726-8911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 RAVEN RD",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "83340",
            "telephone_number": "208-726-7246",
            "fax_number": "208-726-8911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUN VALLEY SPORTS REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2012-06-26",
        "status": "A",
        "authorized_official_last_name": "COYNE",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "PRESIDENT, OWNER",
        "authorized_official_telephone_number": "208-726-7246"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Sports",
            "state": "ID",
            "license": "PT-332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ketchum, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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.