NPIMap

Organization Active NPI

Preston Physical Therapy LLC

  • Physical Therapist
  • Preston, ID
National Provider Identifier
1831424878
Registry record updated Dec 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRESTON PHYSICAL THERAPY LLC
Practice address
10 S 100 W Ste a
Preston, ID 83263-1244
Phone
(208) 852-1143
Fax
(208) 852-3951
NPI assigned
Oct 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2009

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

Authorized official

Name
Charles R Acevedo, PTNPI 1134239254
Title
Member
Phone
(208) 852-1143

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

10 S 100 W Ste a
Preston, ID 83263-1244

Mailing address

PO Box 14
Lewiston, UT 84320-0014
Phone (435) 770-5199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091202000350 ID Part B Supplier - Clinic/Group Practice 0345389490 Receives reassigned benefits from 1 practitioner
Practice locations: Preston, ID

National Provider Directory

National Provider Directory

Locations

10 S 1st W
#A
Preston, ID 83263

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259712000000",
    "number": "1831424878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14",
            "city": "LEWISTON",
            "state": "UT",
            "postal_code": "843200014",
            "telephone_number": "435-770-5199",
            "fax_number": "208-852-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 S 100 W STE A",
            "city": "PRESTON",
            "state": "ID",
            "postal_code": "832631244",
            "telephone_number": "208-852-1143",
            "fax_number": "208-852-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESTON PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2009-12-02",
        "status": "A",
        "authorized_official_last_name": "ACEVEDO",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "208-852-1143",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Preston, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2009; 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.