Active NPI
Laura Moore
- Physical Therapy Assistant
- Rupert, ID
National Provider Identifier
1760837199
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA4619
- Practice address
- 75 E 400 N
Rupert, ID 83350-9571 - Phone
- (208) 431-8386
- NPI assigned
- May 4, 2016
- Last updated
- May 4, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA4619 | ID | Primary |
Addresses
Primary practice location
75 E 400 N
Rupert, ID 83350-9571
Mailing address
75 E 400 N
Rupert, ID 83350-9571
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA4619 | ID | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462320000000",
"number": "1760837199",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "75 E 400 N",
"city": "RUPERT",
"state": "ID",
"postal_code": "833509571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 E 400 N",
"city": "RUPERT",
"state": "ID",
"postal_code": "833509571",
"telephone_number": "208-431-8386"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "LAURA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-05-04",
"last_updated": "2016-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA4619",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rupert, ID
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital
- Minidoka Memorial Hospital Ambulance
- Minidoka Memorial Hospital Crna Group
- Mt. Harrison Audiology and Hearing AIDS LLC
- Brian R Muir, D.O.
- Davee Carpenter Mussmann, DPT
- Marcus E Peterson, DDS
- Christine W. Pickup, AUD CCC-A
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.