Active NPI
Candice Chessum
- Orthopedic Physical Therapist
- Boise, ID
National Provider Identifier
1194193334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- PT-4201
- Practice address
- 1109 W Myrtle St
Boise, ID 83702-6970 - Phone
- (208) 489-4331
- NPI assigned
- Sep 4, 2015
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | PT-4201 | ID | Primary |
Addresses
Primary practice location
1109 W Myrtle St
Boise, ID 83702-6970
Mailing address
323 W Village LN
Boise, ID 83702-6225
Phone (818) 590-1559
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-4201 | ID | MD | Orthopedic Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1441324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1441324800000",
"number": "1194193334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 W VILLAGE LN",
"city": "BOISE",
"state": "ID",
"postal_code": "837026225",
"telephone_number": "818-590-1559"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1109 W MYRTLE ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837026970",
"telephone_number": "208-489-4331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHESSUM",
"first_name": "CANDICE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-09-04",
"last_updated": "2015-09-04",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "ID",
"license": "PT-4201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Sep 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.