Summit Physical Therapy

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SUMMIT PHYSICAL THERAPY

Practice address

152 N Seneca Springs Way # 110
Star, ID 83669-6037

Phone

(208) 995-2913

Fax

(208) 995-2659

NPI assigned

Jul 16, 2024

Organization subpart

No

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

Authorized official

Name

Randall Keith Langley, PTNPI 1598852139

Title

President

Phone

(208) 939-3332

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 3

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

• Sydnie Alexandra Keller

  • Physical Therapist
  • Star, ID
  • NPI 1154261410
  Medicare reassignment Care Compare group NPD
• Randall Keith Langley, RPT, OCS

  • Physical Therapist
  • Eagle, ID
  • NPI 1598852139
  Medicare reassignment NPD Authorized official
• Ian David Tracy, DPT

  • Physical Therapist
  • Boise, ID
  • NPI 1134643885
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1721088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730073600000",
    "number": "1871331702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "457 S FITNESS PL STE 100",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836166568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 N SENECA SPRINGS WAY # 110",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836696037",
            "telephone_number": "208-995-2913",
            "fax_number": "208-995-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-16",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A",
        "authorized_official_last_name": "LANGLEY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-939-3332",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Star Chiropractic, PLLC
• Star Counseling Services LLC
• Star Medical Center PC
• Star Speech and Occupational Therapy LLC
• Star Therapeutic Massage LLC
• TDX5 LLC
• Kevin L Tingey, DDS
• Christina Marie Trindade, MA
• Valley Sleep Diagnostics
• Carol E Ward, RD

• Physical Therapist in Star, ID
• Providers in Star, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2024; 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.