Ma'Lady Jane Kynaston, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA-4121 Issued in ID

Practice address

775 S Rivershore LN Ste 220
Eagle, ID 83616-5783

Phone

(208) 629-1030

NPI assigned

Aug 22, 2024

Last updated

Aug 25, 2024By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Treasure Valley Pelvic Health, LLC

  • Physical Therapist
  • Eagle, ID
  • NPI 1689178469
  NPD

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

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724544000000",
    "number": "1811720121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 S ARCADIA ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837053335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 S RIVERSHORE LN STE 220",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165783",
            "telephone_number": "208-629-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYNASTON",
        "first_name": "MA'LADY",
        "middle_name": "JANE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-25",
        "certification_date": "2024-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "PTA-4121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olga Kondratyuk
• Taylor Kowitz, BSW
• Sharon L Krasovich, M.S., RN, FNP-BC
• Tiffany Jean Krumm, L.P.C.
• Bryant Judson Kusy, LCPC
• Ana Linda Laborde, AGNP-BC
• Kristy Nicole Lageson
• Deena M Lajoie, RD, LD
• Logan Marsh Lamprecht, PH.D., LCPC, M. COUN
• Beth Elaine Landis, NP

• Physical Therapy Assistant in Eagle, ID
• Providers in Eagle, ID by specialty
• Physical Therapy Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2024; 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.