Fitness Forward Physical Therapy PLLC

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

Legal business name

FITNESS FORWARD PHYSICAL THERAPY PLLC

Practice address

1775 E 17TH St Ste D
Idaho Falls, ID 83404-4902

Phone

(208) 243-9999

Fax

(208) 243-9999

NPI assigned

Dec 20, 2017

Organization subpart

No

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

Authorized official

Name

Jon Christopher Mallams, PTA

Title

Pta/Owner

Phone

(208) 424-3999

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513728000000",
    "number": "1881100261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1775 E 17TH ST STE D",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044902",
            "telephone_number": "208-243-9999",
            "fax_number": "208-243-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1775 E 17TH ST STE D",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834044902",
            "telephone_number": "208-243-9999",
            "fax_number": "208-243-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FITNESS FORWARD PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-20",
        "last_updated": "2017-12-20",
        "status": "A",
        "authorized_official_last_name": "MALLAMS",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PTA/OWNER",
        "authorized_official_telephone_number": "208-424-3999",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PTA-3754",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Angela M Fletcher, LCPC
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• Flint R Packer DO PC
• Flower Aston Nutrition LLC

• Physical Therapy Assistant in Idaho Falls, ID
• Providers in Idaho Falls, 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 Dec 20, 2017; 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.