Active NPI
Gayle Bonzer-Fry, PT
- Physical Therapist
- Horseshoe Bend, ID
National Provider Identifier
1144213588
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- RPT-081
- Practice address
- 400 Highway 55
Suite a
Horseshoe Bend, ID 83629-9015 - Phone
- (208) 793-3333
- Fax
- (208) 793-6333
- NPI assigned
- Aug 30, 2005
- Last updated
- Jul 22, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | RPT-081 | ID | Primary |
Addresses
Primary practice location
400 Highway 55
Suite a
Horseshoe Bend, ID 83629-9015
Mailing address
PO Box 205
Horseshoe Bend, ID 83629-0205
Phone (208) 793-3333
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T0239 | Other | ID | BLUE CROSS OF IDAHO |
| 000010008652 | Other | ID | BLUE SHIELD |
| 804131800 | Medicaid | ID |
Other names 1
- Mrs. Elizabeth Gayle Fry
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 |
|---|---|---|---|
| RPT-081 | ID | MD | Physical Therapist |
| 081 | ID | MD | Feeding, Eating & Swallowing Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Physical Therapy P C | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Boise, ID
- NPI 1073551560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374451200000",
"number": "1144213588",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 205",
"city": "HORSESHOE BEND",
"state": "ID",
"postal_code": "836290205",
"telephone_number": "208-793-3333",
"fax_number": "208-793-3666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 HIGHWAY 55",
"address_2": "SUITE A",
"city": "HORSESHOE BEND",
"state": "ID",
"postal_code": "836299015",
"telephone_number": "208-793-3333",
"fax_number": "208-793-6333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONZER-FRY",
"first_name": "GAYLE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-08-30",
"last_updated": "2013-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "RPT-081",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "T0239",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010008652",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "804131800",
"state": "ID"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ELIZABETH",
"last_name": "FRY",
"middle_name": "GAYLE",
"prefix": "MRS.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Horseshoe Bend, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.