Samuel Timothy Hetherington, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-6926 Issued in ID

Practice address

2005 12TH Ave Rd
Nampa, ID 83686-6311

Phone

(208) 463-0022

Fax

(208) 463-0031

NPI assigned

Aug 5, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peak Physical Therapy P C

  • Physical Therapist
  • Boise, ID
  • NPI 1073551560
  NPD

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1093325979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2005 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866311",
            "telephone_number": "208-463-0022",
            "fax_number": "208-463-0031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866311",
            "telephone_number": "208-463-0022",
            "fax_number": "208-463-0031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HETHERINGTON",
        "first_name": "SAMUEL",
        "middle_name": "TIMOTHY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-05",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-6926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PT-6926",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiana Hernandez, LPN
• Olivia Herrell, DC
• Jennifer Herrera
• Barbara Herrington, M.A., CCC-S
• Madison Hesse
• Kathryn R Heydorn
• Scott R Hiatt, D.O.
• Heather Ann Hieb, LCPC
• High Valley Developmental
• Marilyn Nmi Hiller, LCSW-32496

• All providers in Nampa, ID
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; 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.