Active NPI
Jerralyn R Wasylyshen, PT
- Physical Therapist
- Chubbuck, ID
National Provider Identifier
1780952093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-1796
- Practice address
- 4650 Hawthorne Rd Ste 2B
Chubbuck, ID 83202-2376 - Phone
- (208) 238-3349
- NPI assigned
- Dec 1, 2011
- Last updated
- Dec 1, 2011
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225100000X | PT-1796 | ID | Primary |
Addresses
Primary practice location
4650 Hawthorne Rd Ste 2B
Chubbuck, ID 83202-2376
Mailing address
PO Box 6032
Pocatello, ID 83205-6032
Phone (208) 238-3349
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-1796 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northrup Physical Therapy, PC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Chubbuck, ID
- NPI 1629146857
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1322697600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322697600000",
"number": "1780952093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6032",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832056032",
"telephone_number": "208-238-3349"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 HAWTHORNE RD STE 2B",
"city": "CHUBBUCK",
"state": "ID",
"postal_code": "832022376",
"telephone_number": "208-238-3349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WASYLYSHEN",
"first_name": "JERRALYN",
"middle_name": "R",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-01",
"last_updated": "2011-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-1796",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chubbuck, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 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.