NPIMap

Organization Active NPI

Nichols Therapy Group PC

Doing business as NorthStar Physical Therapy

  • Physical Therapist
  • Star, ID
National Provider Identifier
1043380769
Registry record updated Jun 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1136 Issued in ID
Legal business name
NICHOLS THERAPY GROUP PC
Doing business as
NorthStar Physical Therapy
Practice address
9652 W State Street
Star, ID 83669-5858
Phone
(208) 286-0766
Fax
(208) 286-0768
NPI assigned
Nov 9, 2006
Last updated
Jun 29, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2012

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

Authorized official

Name
Mr. Brian David Nichols, MPTNPI 1679679088
Title
President
Phone
(208) 286-0766

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 1136 ID Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X RPT1371 ID
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X RPT1136 ID

Addresses

Primary practice location

9652 W State Street
Star, ID 83669-5858

Mailing address

9652 W State Street
Star, ID 83669-5858
Phone (208) 286-0766

Other names 1

  • NorthStar Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040716000273 ID Part B Supplier - Clinic/Group Practice 0345229068 Receives reassigned benefits from 7 practitioners
Practice locations: Star, ID

National Provider Directory

National Provider Directory

Locations

9652 W State St
Star, ID 83669
Phone (208) 286-0766

9652 W State St
#T
Star, ID 83669
Phone (208) 286-0766

9882 W State St
Ste C
Star, ID 83669
Phone (208) 286-0766

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1043380769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9652 W STATE STREET",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695858",
            "telephone_number": "208-286-0766",
            "fax_number": "208-286-0768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9652 W STATE STREET",
            "city": "STAR",
            "state": "ID",
            "postal_code": "836695858",
            "telephone_number": "208-286-0766",
            "fax_number": "208-286-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NICHOLS THERAPY GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-286-0766",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "1136",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "RPT1371",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "RPT1136",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthStar Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Star, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.