Active NPI
Rebecca Stout, P.T.A
- Massage Therapist
- Grangeville, ID
National Provider Identifier
1821412388
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- CCMT-23-71
- Practice address
- 295 Black Tail LN
Grangeville, ID 83530-5099 - Phone
- (208) 451-4752
- NPI assigned
- Feb 4, 2014
- Last updated
- Mar 20, 2025
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA2635 | ID | |
| Massage Therapist | 225700000X | CCMT-23-71 | WY | Primary |
Addresses
Primary practice location
295 Black Tail LN
Grangeville, ID 83530-5099
Mailing address
1317 Plum St
Cheyenne, WY 82007-3333
Phone (208) 451-4752
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 |
|---|---|---|---|
| PTA2635 | ID | MD | Physical Therapy Assistant |
| CCMT-23-71 | WY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391472000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742428800000",
"number": "1821412388",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1317 PLUM ST",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820073333",
"telephone_number": "208-451-4752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "295 BLACK TAIL LN",
"city": "GRANGEVILLE",
"state": "ID",
"postal_code": "835305099",
"telephone_number": "208-451-4752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STOUT",
"first_name": "REBECCA",
"credential": "P.T.A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-04",
"last_updated": "2025-03-20",
"certification_date": "2025-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA2635",
"primary": false
},
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "WY",
"license": "CCMT-23-71",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grangeville, ID
- Susan Christine Smith, RN
- Teresa Lynn Soderling, FNP-C
- St. Mary's Hospital Inc (St. Mary's Grangeville Clinic)
- St. Mary's Hospital Inc (Grangeville Physical Therapy)
- Renee Joy Stevens
- Syringa General Hospital
- Syringa General Hospital District C I F (Syringa Primary Care Clinic)
- Syringa General Hospital District C I F (Syringa General Hospital Hospice)
- Syringa General Hospital District C I F
- Syringa General Hospital District C I F
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.