Joel Cruz, PT
Individual provider Active NPI Physical Therapist · Shelley, ID
NPI 1003382276 · NPPES record last updated Apr 22, 2024
Key facts
- NPI
- 1003382276
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-7250 (ID)
- Practice address
- 186 W Pine St
Shelley, ID 83274-1235 - Phone
- (208) 680-4787
- NPI assigned
- Oct 16, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cruz Therapy Services
Practice addresses (Care Compare)
186 W Pine St
Shelley, ID 83274-1235
Phone (208) 932-0108
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210726001401 | ID | Practitioner - Physical Therapist in Private Practice | 0648673897 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-4520 | ID | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cruz Therapy Services | Physical Therapist | Current |
Accepting new patients |
| Rocky Mountain Physical Therapy PLLC | Physical Therapist | Current |
Accepting new patients |
Locations
1441 Parkway Dr
Ste 1
Blackfoot, ID 83221
Phone (208) 785-3446
1441 Parkway Dr
Blackfoot, ID 83221
Phone (208) 785-2600
186 W Pine St
Shelley, ID 83274
Phone (208) 680-4787
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA-4520 | ID | |
| Physical Therapist | 225100000X | PT-7250 | ID | Yes |
Addresses
Primary practice location
186 W Pine St
Shelley, ID 83274-1235
Mailing address
400 Grant St
Blackfoot, ID 83221-2119
Phone (208) 680-4787
Other practice location 1
1441 Parkway Dr
Blackfoot, ID 83221-1667
Phone (208) 785-3446
Other practice location 2
1957 Alvin Ricken Dr
Pocatello, ID 83201-2727
Phone (208) 235-7800
Other providers in Shelley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.