Idaho Family Physical Therapy PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

IDAHO FAMILY PHYSICAL THERAPY PLLC

Doing business as

Idaho Family PT

Practice address

2422 12TH Ave Rd
Nampa, ID 83686-6300

Phone

(425) 375-8991

NPI assigned

Dec 9, 2022

Last updated

Feb 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Connor Todd Brown, PT, DPT, CERTDNNPI 1235713090

Title

Owner

Phone

(425) 375-8991

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Idaho Family PT Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Practitioners 2

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.

• Connor Brown, DPT

  • Physical Therapist
  • Nampa, ID
  • NPI 1235713090
  Medicare reassignment Care Compare group NPD Authorized official
• Dale Edward Moote, PT

  • Physical Therapist
  • Milwaukie, OR
  • NPI 1851557805

  ID

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1184335184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 CHICAGO ST",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836867301",
            "telephone_number": "208-466-0566",
            "fax_number": "208-697-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 12TH AVE RD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836866300",
            "telephone_number": "425-375-8991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO FAMILY PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-09",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "CONNOR",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-375-8991",
        "authorized_official_credential": "PT, DPT, CERTDN"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235713090",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@idahofamilypt.com",
            "affiliation": "N",
            "endpointDescription": "Clinic Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Email Address",
            "address_1": "2422 12th Ave Rd",
            "city": "Nampa",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836866300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Idaho Family PT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Idaho Department of Health and Welfare Esc Region III
• Idaho Dept of Health & Welfare Itp Region 3
• Idaho Em-I Medical Services PC
• Idaho Endoscopy Center LLC (Nampa Idaho Endoscopy Center)
• Idaho Eye Pros of Nampa
• Idaho Medical Products
• Idaho Medical Products
• Idaho Mental Wellness & Addiction Recovery PLLC
• Idaho Pediatric Dentistry
• Idaho Pediatric Dentistry

• Physical Therapy Clinic/Center in Nampa, ID
• Providers in Nampa, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.