1174699342 NPI number — ASPEN PHYSICAL THERAPY LLP

Table of content: MS. ELIZABETH MARSHALL WHITTINGTON LICSW, CDP (NPI 1427105543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174699342 NPI number — ASPEN PHYSICAL THERAPY LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASPEN PHYSICAL THERAPY LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174699342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 GARRETT WAY
Provider Second Line Business Mailing Address:
STE 19A
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-5132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-233-1064
Provider Business Mailing Address Fax Number:
208-233-0219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 GARRETT WAY
Provider Second Line Business Practice Location Address:
STE 19A
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-5132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-233-1064
Provider Business Practice Location Address Fax Number:
208-233-0219
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
BRANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-233-1064

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT1078 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT1555 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85120066610450 . This is a "REGENCY (BRANDI SCOTT)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: TD471 . This is a "BCID (BART MCDONALD)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 0000-10144181 . This is a "BSID (BRANDI SCOTT)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: TA401 . This is a "BCID (BRANDI SCOTT)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 5479460 . This is a "CCN (BRANDI SCOTT)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: TA393 . This is a "BCID (ASPEN PT)" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 7042522 . This is a "AETNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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