Alicia G Siddoway, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT437 Issued in ID

Practice address

1 Professional PLZ
Rexburg, ID 83440-2024

Phone

(208) 359-2500

Fax

(208) 359-2502

NPI assigned

Apr 24, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1983

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Physical Therapy and Wound Center, PLLCGroup PAC ID 2567684640, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Advanced Physical Therapy & Wound Center, PLLC

  • Physical Therapist
  • Rexburg, ID
  • NPI 1356754147

  ID, Physical Therapist

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1208995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1679748248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PLZ",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402024",
            "telephone_number": "208-359-2500",
            "fax_number": "208-359-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 PROFESSIONAL PLZ",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402024",
            "telephone_number": "208-359-2500",
            "fax_number": "208-359-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDDOWAY",
        "first_name": "ALICIA",
        "middle_name": "G",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-24",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trent E Shaw, PA-C
• Julie B. Shiffler, PH.D.
• Justin Shippen, DO
• Emily Shore, LCSW
• Adam Louis Shurtz, DPT
• Matthew Galland Silva
• Gracie Allene Simmons
• Stephanie Ann Sims
• Steven G Sjoblom, CCC-SLP
• Skinlab 360 Dermatology & Aesthetics LLC

• All providers in Rexburg, ID
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.