| Spine And Sport Pysical Therapy Pc | |
|
217 N 2nd East, Rexburg, ID 83440-1621 | |
| (208) 359-6127 | |
| (208) 359-9479 |
| Full Name | Spine And Sport Pysical Therapy Pc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 217 N 2nd East, Rexburg, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992975825 | NPI | - | NPPES |
| 650015362 | Other | RAILROAD MEDICARE | |
| 000010020600 | Other | ID | REGENCE BLUE SHIELD |
| 1210564 | Medicaid | WY | |
| T3860 | Other | ID | BLUE CROSS |
| 185556100 | Other | US DEPARTMENT OF LABOR | |
| 805399800 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 1346 (Idaho) | Primary |
| Provider Name | Jody B Rawlings |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1497897458 PECOS PAC ID: 2567459167 Enrollment ID: I20040427000919 |
| Provider Name | Mark J Coglianese |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912912791 PECOS PAC ID: 1052490596 Enrollment ID: I20191024003167 |
| Provider Name | Kaden Sutherland |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912697541 PECOS PAC ID: 2365800992 Enrollment ID: I20230614001125 |
| Provider Name | Jesse Ruivivar Castillo |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1760267371 PECOS PAC ID: 1153778295 Enrollment ID: I20231109003722 |
| Mailing Address | Practice Location Address |
|---|---|
| Spine And Sport Pysical Therapy Pc 217 N 2nd East, Rexburg, ID 83440-2057 Ph: (208) 359-6127 | Spine And Sport Pysical Therapy Pc 217 N 2nd East, Rexburg, ID 83440-1621 Ph: (208) 359-6127 |
Jakob Carstens, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1 Professional Plz, Rexburg, ID 83440 Phone: 208-359-2500 Fax: 208-359-2502 | |
Clark Dabell, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1 Professional Plz, Rexburg, ID 83440 Phone: 208-359-2500 Fax: 208-359-2502 | |
Cordell Pickering, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 526 First American Cir Ste B, Rexburg, ID 83440 Phone: 208-534-7001 | |
Cody Lane Castellaw, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 393 E 2nd N, Rexburg, ID 83440 Phone: 208-359-9570 | |
Anthony Humphries, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 1 Professional Plz, Rexburg, ID 83440 Phone: 208-359-2500 Fax: 208-359-2502 | |
Morgan Jesse Ricks, Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 36 Winn Dr Ste 100, Rexburg, ID 83440 Phone: 208-356-0174 Fax: 208-356-0176 | |
George Garald Griffeth, MSPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 450 E Main St, Rexburg, ID 83440 Phone: 208-359-6532 |