Kelly P Sadauckas, PT, DPT, OCS, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-2689 Issued in ID

Practice address

18 North Main St
Suite 215
Driggs, ID 83422

Phone

(208) 354-1999

NPI assigned

Nov 10, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly P Danko Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372636800000",
    "number": "1992006761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 ASHLEY AVE",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "834225210",
            "telephone_number": "208-473-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 NORTH MAIN ST",
            "address_2": "SUITE 215",
            "city": "DRIGGS",
            "state": "ID",
            "postal_code": "83422",
            "telephone_number": "208-354-1999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SADAUCKAS",
        "first_name": "KELLY",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "PT, DPT, OCS, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-10",
        "last_updated": "2013-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-2689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "DANKO",
            "middle_name": "P",
            "credential": "PT, DPT, CSCS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2013; 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.