Provider Demographics
NPI:1174699342
Name:ASPEN PHYSICAL THERAPY LLP
Entity type:Organization
Organization Name:ASPEN PHYSICAL THERAPY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:208-233-1064
Mailing Address - Street 1:1800 GARRETT WAY
Mailing Address - Street 2:STE 19A
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-5132
Mailing Address - Country:US
Mailing Address - Phone:208-233-1064
Mailing Address - Fax:208-233-0219
Practice Address - Street 1:1800 GARRETT WAY
Practice Address - Street 2:STE 19A
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5132
Practice Address - Country:US
Practice Address - Phone:208-233-1064
Practice Address - Fax:208-233-0219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT1078225100000X
IDPT1555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID85120066610450OtherREGENCY (BRANDI SCOTT)
IDTD471OtherBCID (BART MCDONALD)
ID0000-10144181OtherBSID (BRANDI SCOTT)
IDTA401OtherBCID (BRANDI SCOTT)
ID5479460OtherCCN (BRANDI SCOTT)
IDTA393OtherBCID (ASPEN PT)
ID7042522OtherAETNA
IDTD471OtherBCID (BART MCDONALD)
IDTA393OtherBCID (ASPEN PT)
IDP00320548Medicare ID - Type UnspecifiedBART MCDONALD'S MEDICARE
ID85120066610450OtherREGENCY (BRANDI SCOTT)
ID1377796Medicare ID - Type UnspecifiedCLINIC MEDICARE NUMBER