Prime Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

PRIME PHYSICAL THERAPY LLC

Practice address

30 S Maple St
Blackfoot, ID 83221-2128

Phone

(208) 684-0021

NPI assigned

Dec 20, 2021

Organization subpart

No

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

Authorized official

Name

Jessica Annelaine VandykeNPI 1104394659

Title

Owner

Phone

(208) 233-2248

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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

• Jessica Annelaine Vandyke, DPT

  • Physical Therapist
  • Blackfoot, ID
  • NPI 1104394659
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1639958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760486400000",
    "number": "1851051718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 S MAPLE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212128",
            "telephone_number": "208-684-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 S MAPLE ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212128",
            "telephone_number": "208-684-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-20",
        "last_updated": "2025-10-15",
        "certification_date": "2025-10-15",
        "status": "A",
        "authorized_official_last_name": "VANDYKE",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "ANNELAINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-233-2248"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Potter
• Kay M Powell, NP
• Lindsey Kaye Pratt
• Anne Marie Preston, L.C.S.W
• Lori Marie Preston, LPN
• Kathy Puckett, RDLDCDE
• Heather D Pugmire, M.D.
• Blake G Purcell, CRNA
• Brian Blake Purcell, CRNA
• Terri Lea Quilici

• Physical Therapy Clinic/Center in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2025; 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.