Stacey L Scanlan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1355 Issued in ID

Practice address

2302 N Bogus Basin Road
Suite C
Boise, ID 83702

Phone

(208) 344-0730

Fax

(208) 344-0759

NPI assigned

Oct 19, 2006

Last updated

Oct 7, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Focus Physical Therapy

  • Physical Therapy Clinic/Center
  • Boise, ID
  • NPI 1003962036
  NPD (past)
• Columbia Physical Therapy Inc PS

  • Physical Therapist
  • Kennewick, WA
  • NPI 1457397531
  NPD (past)

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317945600000",
    "number": "1689756603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 N BOGUS BASIN ROAD",
            "address_2": "SUITE C",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-344-0737",
            "fax_number": "208-344-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2302 N BOGUS BASIN ROAD",
            "address_2": "SUITE C",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83702",
            "telephone_number": "208-344-0730",
            "fax_number": "208-344-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCANLAN",
        "first_name": "STACEY",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2011-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1355",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "ID",
            "license": "PT1355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "THRIVE PT AND PILATES GROUP NPI",
            "identifier": "1578799094",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102560035",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberlee Sue Saxton, LCSW
• Kourtney Saxton, AT, LAT
• Jaren Layne Sayer, DC CCEP
• Elizabeth Sayre, MSSA
• Kathleen M Scanlan, MD
• Kristine Scanlon
• Erika L Scarberry
• Emma M. Schaber
• Mikayla Schachtell
• Elizabeth Ann Schackmann, MD

• Physical Therapist in Boise, ID
• Providers in Boise, 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 7, 2011; 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.