NPIMap

Organization Active NPI

62 Degrees Physical Therapy

Doing business as Myofascial Release Center

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1154743912
Registry record updated Jan 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT632 Issued in ID
Legal business name
62 DEGREES PHYSICAL THERAPY
Doing business as
Myofascial Release Center
Practice address
8660 W Emerald St
Boise, ID 83704-4825
Phone
(208) 321-7831
Fax
(208) 995-2870
NPI assigned
Jan 14, 2014
Last updated
Jan 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2014

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

Authorized official

Name
Dr. Katrin Hurley Moffett, PT, DPT, CWS, FACCWSNPI 1568892081
Title
Owner/Member
Phone
(208) 321-7831

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT632 ID Primary

Addresses

Primary practice location

8660 W Emerald St
Boise, ID 83704-4825

Mailing address

8660 W Emerald St
Boise, ID 83704-4825
Phone (208) 321-7831

Other names 1

  • Myofascial Release Center Doing business as

National Provider Directory

National Provider Directory

Locations

8660 W Emerald St
Boise, ID 83704
Phone (208) 321-7831

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389657600000",
    "number": "1154743912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8660 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044825",
            "telephone_number": "208-321-7831",
            "fax_number": "208-995-2870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8660 W EMERALD ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044825",
            "telephone_number": "208-321-7831",
            "fax_number": "208-995-2870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "62 DEGREES PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-14",
        "last_updated": "2014-01-14",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "KATRIN",
        "authorized_official_middle_name": "HURLEY",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "208-321-7831",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, CWS, FACCWS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Myofascial Release Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 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.

Verify at the official NPI Registry.