Active NPI
John C Koth, MPT
- Physical Therapist
- Ketchum, ID
National Provider Identifier
1124110002
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- RPT614
- Practice address
- 101 Saddle Road
Ketchum, ID 83340-1510 - Phone
- (208) 726-9222
- Fax
- (208) 726-1607
- NPI assigned
- Sep 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | RPT614 | ID | Primary |
| Sports Physical Therapist | 2251S0007X | RPT614 | ID | |
| Orthopedic Physical Therapist | 2251X0800X | RPT614 | ID |
Addresses
Primary practice location
101 Saddle Road
Ketchum, ID 83340-1510
Mailing address
PO Box 1510
Ketchum, ID 83340-1510
Phone (208) 788-3997
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPT614 | ID | MD | Sports Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Koth Sports Physical Therapy, PA | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Ketchum, ID
- NPI 1265524045
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1124110002",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1510",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833401510",
"telephone_number": "208-788-3997",
"fax_number": "208-726-1607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 SADDLE ROAD",
"city": "KETCHUM",
"state": "ID",
"postal_code": "833401510",
"telephone_number": "208-726-9222",
"fax_number": "208-726-1607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOTH",
"first_name": "JOHN",
"middle_name": "C",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-29",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "RPT614",
"primary": true
},
{
"code": "2251S0007X",
"taxonomy_group": "",
"desc": "Physical Therapist, Sports",
"state": "ID",
"license": "RPT614",
"primary": false
},
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "ID",
"license": "RPT614",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ketchum, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.