NPIMap

Organization Active NPI

Ironwood Drive Physical Therapy, PA

  • Physical Therapist
  • Coeur D Alene, ID
National Provider Identifier
1801812482
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
IRONWOOD DRIVE PHYSICAL THERAPY, PA
Practice address
1450 Northwest Blvd Ste 106
Coeur D Alene, ID 83814-5605
Phone
(208) 667-6264
Fax
(208) 664-4313
NPI assigned
Jul 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Authorized official

Name
Dirk Anthony Baird, DPTNPI 1225149123
Title
Owner
Phone
(208) 667-6264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1450 Northwest Blvd Ste 106
Coeur D Alene, ID 83814-5605

Mailing address

1450 Northwest Blvd Ste 106
Coeur D Alene, ID 83814-5605
Phone (208) 667-6264

Other names 1

  • Hayden Lake Physical Therapy and Aquatics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040617000362 ID Part B Supplier - Clinic/Group Practice 1557345436 Receives reassigned benefits from 12 practitioners
Practice locations: Coeur D Alene, ID; Post Falls, ID

National Provider Directory

National Provider Directory

Locations

7780 N Mineral Dr
Coeur D Alene, ID 83815
Phone (208) 772-6609

1450 Northwest Blvd
Ste 106
Coeur D Alene, ID 83814
Phone (208) 667-6264

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1152921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583798400000",
    "number": "1801812482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 NORTHWEST BLVD STE 106",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145605",
            "telephone_number": "208-667-6264",
            "fax_number": "208-664-4313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 NORTHWEST BLVD STE 106",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838145605",
            "telephone_number": "208-667-6264",
            "fax_number": "208-664-4313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRONWOOD DRIVE PHYSICAL THERAPY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-15",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A",
        "authorized_official_last_name": "BAIRD",
        "authorized_official_first_name": "DIRK",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-667-6264",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hayden Lake Physical Therapy and Aquatics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coeur D Alene, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.