Prime Physical Therapy Llc is a medicare enrolled "Clinic/center - Physical Therapy" provider in Blackfoot, Idaho. Their current practice location is
282 W Bridge St, Blackfoot, Idaho. You can reach out to their office (for appointments etc.) via phone at
(208) 684-0021.
Prime Physical Therapy Llc is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Prime Physical Therapy Llc
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1851051718.
Healthcare Provider's Profile
| Full Name | Prime Physical Therapy Llc |
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| Type | Facility |
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| Speciality | Clinic/center - Physical Therapy |
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| Location | 282 W Bridge St, Blackfoot, Idaho |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1851051718
- Provider Enumeration Date: 12/20/2021
- Last Update Date: 09/13/2022
Medicare PECOS Information:
- PECOS PAC ID: 1153717418
- Enrollment ID: O20220413002146
Medical Identifiers
Medical identifiers for Prime Physical Therapy Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1851051718 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 225100000X | Physical Therapist | (* (Not Available)) | Secondary |
| 261QP2000X | Clinic/center - Physical Therapy | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Prime Physical Therapy Llc acts as a billing entity for following providers:
| Provider Name | Jessica Annelaine Vandyke |
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| Provider Type | Practitioner - Physical Therapist In Private Practice |
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| Provider Identifiers | NPI Number: 1104394659
PECOS PAC ID: 9931448305
Enrollment ID: I20190301000069 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Prime Physical Therapy Llc is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Prime Physical Therapy Llc
1441 Larry Ln,
Blackfoot, ID 83221-5034
Ph: (406) 422-6133 | Prime Physical Therapy Llc
282 W Bridge St,
Blackfoot, ID 83221
Ph: (208) 684-0021 |
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