| Jerome Physical Therapy & Sports Medicine Clinic | |
|
128 5th Ave West, Jerome, ID 83338 | |
| (208) 324-3090 | |
| (208) 324-3093 |
| Full Name | Jerome Physical Therapy & Sports Medicine Clinic |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 128 5th Ave West, Jerome, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265527725 | NPI | - | NPPES |
| PENDING | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT-1686 (Idaho) | Primary |
| 2255A2300X | Specialist/technologist - Athletic Trainer | PENDING (Idaho) | Secondary |
| Provider Name | Lon M Egbert |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437130952 PECOS PAC ID: 0143324392 Enrollment ID: I20070328000646 |
| Provider Name | Charles T Carter |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1255740866 PECOS PAC ID: 1951522879 Enrollment ID: I20151031000010 |
| Provider Name | Jaron D Pope |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1174990550 PECOS PAC ID: 1254640667 Enrollment ID: I20160415001189 |
| Provider Name | Tyler Egbert |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1467909317 PECOS PAC ID: 5597144733 Enrollment ID: I20220620000251 |
| Mailing Address | Practice Location Address |
|---|---|
| Jerome Physical Therapy & Sports Medicine Clinic Po Box 565, Jerome, ID 83338 Ph: (208) 324-3090 | Jerome Physical Therapy & Sports Medicine Clinic 128 5th Ave West, Jerome, ID 83338 Ph: (208) 324-3090 |
Dr. Daryl Dean Mayes, P.T., D.P.T., M.H.S. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1976 S Lincoln Ave, Suite 6a, Jerome, ID 83338 Phone: 208-644-1433 Fax: 208-644-1434 | |
Ms. Donna Starodoj Alfs, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 128 5th Ave W, Jerome, ID 83338 Phone: 208-324-3090 | |
Scott Reid Mason, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 111 Pioneer Ct, Jerome, ID 83338 Phone: 208-944-9277 Fax: 208-944-9280 | |
Lon Miguel Egbert, PT, ATC Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 128 5th Ave W, Jerome, ID 83338 Phone: 208-324-3090 Fax: 208-324-3093 | |
Austin Cobbley, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 111 Pioneer Ct, Jerome, ID 83338 Phone: 208-944-9277 Fax: 208-944-9280 | |
Clinton Axman, PT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 128 5th Ave W, Jerome, ID 83338 Phone: 208-324-3090 Fax: 208-324-3093 |