NPIMap

Organization Active NPI

Physical Therapy Centers of Idaho

  • Physical Therapy Clinic/Center
  • Boise, ID
National Provider Identifier
1184779514
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PHYSICAL THERAPY CENTERS OF IDAHO
Practice address
8854 W Emerald St
Suite 280
Boise, ID 83704-4844
Phone
(208) 377-5005
Fax
(208) 377-8484
NPI assigned
Jan 24, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
David Ray, MSPT, ATC, CSCSNPI 1386685493
Title
Owner
Phone
(208) 377-5005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X ID Primary

Addresses

Primary practice location

8854 W Emerald St
Suite 280
Boise, ID 83704-4844

Mailing address

8854 W Emerald St
Suite 280
Boise, ID 83704-4844
Phone (208) 377-5005

Other names 1

  • Idaho Physical Therapy Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040710000177 ID Part B Supplier - Clinic/Group Practice 8224016860 Receives reassigned benefits from 5 practitioners
Practice locations: Boise, ID; Meridian, ID

National Provider Directory

National Provider Directory

Locations

8854 W Emerald St
Ste 280
Boise, ID 83704
Phone (208) 377-5005

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1184779514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST",
            "address_2": "SUITE 280",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044844",
            "telephone_number": "208-377-5005",
            "fax_number": "208-377-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8854 W EMERALD ST",
            "address_2": "SUITE 280",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837044844",
            "telephone_number": "208-377-5005",
            "fax_number": "208-377-8484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY CENTERS OF IDAHO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-377-5005",
        "authorized_official_credential": "MSPT, ATC, CSCS"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Physical Therapy",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Jul 21, 2022; 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.