NPIMap

Organization Active NPI

Renew Manual Physical Therapy PLLC

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1013436641
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-5245 Issued in ID
Legal business name
RENEW MANUAL PHYSICAL THERAPY PLLC
Practice address
7444 W Saxton Dr # K101
Boise, ID 83714-1316
Phone
(602) 515-6659
NPI assigned
Sep 14, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Breann Faye Suddock Fox, PT, DPT, PRPCNPI 1184059941
Title
Owner/Therapist
Phone
(602) 515-6659

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT-5245 ID Primary

Addresses

Primary practice location

7444 W Saxton Dr # K101
Boise, ID 83714-1316

Mailing address

7444 W Saxton Dr # K101
Boise, ID 83714-1316
Phone (602) 515-6659

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013436641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7444 W SAXTON DR # K101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141316",
            "telephone_number": "602-515-6659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7444 W SAXTON DR # K101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837141316",
            "telephone_number": "602-515-6659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEW MANUAL PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-14",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "BREANN",
        "authorized_official_middle_name": "FAYE SUDDOCK",
        "authorized_official_title_or_position": "OWNER/THERAPIST",
        "authorized_official_telephone_number": "602-515-6659",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, PRPC"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-5245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.