Phoenix Physical Therapy PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PHOENIX PHYSICAL THERAPY PLLC

Practice address

4676 Weigel Cir
Iona, ID 83427-4907

Phone

(208) 754-2127

NPI assigned

Dec 2, 2024

Last updated

Dec 2, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Matthew Ricci, P.T.NPI 1023675287

Title

Owner, Authorized Official, Provide

Phone

(208) 754-2127

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Matthew John Ricci, DPT

  • Physical Therapist
  • Shelley, ID
  • NPI 1023675287
  Medicare reassignment Care Compare group NPD Authorized official
• Colby C Ebanks, PT, DPT

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1639745540
  Medicare reassignment Care Compare group NPD
• Chandler Rose, P.T.

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1295668770
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1733097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733097600000",
    "number": "1992521215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4676 WEIGEL CIR",
            "city": "IONA",
            "state": "ID",
            "postal_code": "834274907",
            "telephone_number": "208-754-2127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4676 WEIGEL CIR",
            "city": "IONA",
            "state": "ID",
            "postal_code": "834274907",
            "telephone_number": "208-754-2127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-02",
        "last_updated": "2024-12-02",
        "certification_date": "2024-12-02",
        "status": "A",
        "authorized_official_last_name": "RICCI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER, AUTHORIZED OFFICIAL, PROVIDE",
        "authorized_official_telephone_number": "208-754-2127",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Cruz, LSW
• Anna Marie Hansen
• Ryan Hatch
• David S Hinton
• Erin Longmore, RDN
• Thomas David Stohel
• Therapy for Life

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 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.