Atlas Performance Rehab PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

ATLAS PERFORMANCE REHAB PC

Practice address

4133 N Garton LN
Pocatello, ID 83204-7102

Phone

(208) 269-2360

Fax

(208) 550-3256

NPI assigned

Jul 31, 2024

Last updated

Jul 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Blaire Zikratch-Clayson, PTNPI 1538453360

Title

Owner

Phone

(208) 269-2360

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Blaire M Zikratch-Clayson, DPT

  • Physical Therapist
  • Pocatello, ID
  • NPI 1538453360
  Authorized official Same address or phone

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

{
    "created_epoch": "1722384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1679302335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 N GARTON LN",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832047102",
            "telephone_number": "208-269-2360",
            "fax_number": "208-550-3256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 N GARTON LN",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832047102",
            "telephone_number": "208-269-2360",
            "fax_number": "208-550-3256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLAS PERFORMANCE REHAB PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-31",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A",
        "authorized_official_last_name": "ZIKRATCH-CLAYSON",
        "authorized_official_first_name": "BLAIRE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-269-2360",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.