Douglas Wayne Ball, M.P.T. A.T.C.
Individual provider Active NPI Physical Therapist · Soda Springs, ID
NPI 1891916359 · NPPES record last updated Sep 30, 2019
Key facts
- NPI
- 1891916359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-1662 (ID)
- Practice address
- 316 W 2ND S
Soda Springs, ID 83276-1515 - Phone
- (208) 547-3125
- Fax
- (208) 547-0715
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1998
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
316 W 2ND
Soda Springs, ID 83276-1515
Phone (208) 547-3125
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190410001528 | ID | Practitioner - Physical Therapist in Private Practice | 6305895137 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PT Works Inc | Physical Therapist | Current |
Accepting new patients |
Locations
316 W 2nd S
Soda Springs, ID 83276
Phone (208) 233-4660
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Physical Therapist | 225100000X | PT-1662 | ID | Yes |
Addresses
Primary practice location
316 W 2ND S
Soda Springs, ID 83276-1515
Mailing address
801 S 1St E
Grace, ID 83241-5386
Phone (208) 425-9199
Other providers in Soda Springs, ID
- Patrish Doreen Barrick
- Bear River Chiropractic, LLC
- Bear River Vision, LLC
- Bear River Vision, PC
- Brenda Bergholm
All providers in Soda Springs, ID · Physical Therapist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.