Sophia M Garrett, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-6682 Issued in ID

Practice address

265 E Chubbuck Rd Ste a
Chubbuck, ID 83202-5055

Phone

(208) 417-0011

Fax

(888) 437-2431

NPI assigned

Aug 10, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Custom Rehab LLCGroup PAC ID 4385811454, 6 clinicians

Practice addresses (Care Compare)

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.

• Custom Rehab LLC

  • Physical Therapist
  • Chubbuck, ID
  • NPI 1215204862
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1597017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597017600000",
    "number": "1124639653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 E CHUBBUCK RD STE A",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025055",
            "telephone_number": "208-417-0011",
            "fax_number": "888-437-2431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 E CHUBBUCK RD STE A",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025055",
            "telephone_number": "208-417-0011",
            "fax_number": "888-437-2431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARRETT",
        "first_name": "SOPHIA",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-10",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-6682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Andrew Flicker, MPT, DPT, CSCS
• Sarah Flores, PARAPROFESSIONAL
• Branson Lee Fonnesbeck, PT, DPT
• Forza Physical Therapy PLLC
• Kayla R Frandsen, LMSW
• Emma Garritson
• Madison Gates
• Gem Prep Pocatello, Inc
• Olivia George, PARAPROFESSIONAL
• Gerald L Knouf MD PA

• Physical Therapist in Chubbuck, ID
• Providers in Chubbuck, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.