NPIMap

Organization Active NPI

BK Inc.

Doing business as Moscow Mountain Sport and Physical Therapy

  • Physical Therapy Clinic/Center
  • Moscow, ID
National Provider Identifier
1659429405
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BK INC.
Doing business as
Moscow Mountain Sport and Physical Therapy
Practice address
872 Troy Rd Ste 180
Moscow, ID 83843-4046
Phone
(208) 882-1426
Fax
(208) 882-1428
NPI assigned
Jan 8, 2007
Last updated
Aug 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

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

Authorized official

Name
Kelly Isakson, PTNPI 1477606119
Title
Owner
Phone
(208) 882-1426

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

872 Troy Rd Ste 180
Moscow, ID 83843-4046

Mailing address

872 Troy Rd Ste 180
Moscow, ID 83843-4046
Phone (208) 882-1426

Other names 1

  • Moscow Mountain Sport and Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070828000276 ID Part B Supplier - Clinic/Group Practice 6406948090 Receives reassigned benefits from 8 practitioners
Practice locations: Moscow, ID

National Provider Directory

National Provider Directory

Locations

225 E Palouse River Dr
Moscow, ID 83843
Phone (208) 882-1426

872 Troy Rd
Ste 180
Moscow, ID 83843
Phone (208) 882-1426

904 White Ave
Moscow, ID 83843
Phone (208) 596-1056

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1659429405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 TROY RD STE 180",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838434046",
            "telephone_number": "208-882-1426",
            "fax_number": "208-882-1428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 TROY RD STE 180",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838434046",
            "telephone_number": "208-882-1426",
            "fax_number": "208-882-1428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BK INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-08-17",
        "status": "A",
        "authorized_official_last_name": "ISAKSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-882-1426",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moscow Mountain Sport and Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; 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.