Jarrod Charles Brownsberger, DPT
Individual provider Active NPI Physical Therapy Clinic/Center · Chubbuck, ID
NPI 1114495751 · NPPES record last updated Nov 12, 2018
Key facts
- NPI
- 1114495751
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- License
- PT5030 (ID)
- Practice address
- 4922 Yellowstone Ave Ste J
Chubbuck, ID 83202-2360 - Phone
- (208) 237-1882
- NPI assigned
- Nov 12, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT5030 | ID | MD | Physical Therapy Clinic/Center |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Flicker Physical Therapy LLC | Physical Therapy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | PT5030 | ID | Yes |
Addresses
Primary practice location
4922 Yellowstone Ave Ste J
Chubbuck, ID 83202-2360
Mailing address
145 S 18TH Ave
Pocatello, ID 83201-3342
Phone (208) 317-9841
Other providers in Chubbuck, ID
- Stephanie Lee Brannon
- Susanna Branson
- Brent Leavitt
- Ashley Bringhurst
- Scott Broberg
- Blake J Buffat
- Leslie Irene Burnside
- Michael Burrow
- Travis Burton
- Darren Hank Butler
All providers in Chubbuck, ID · Physical Therapy Clinic/Center in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 12, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.