Individual provider Active NPI

Samuel Taylor Mulford, PT, DPT

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1194349381
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7621 Issued in ID
Practice address
554 N Steelhead Way Ste 162
Boise, ID 83704-8388
Phone
(208) 323-9747
Fax
(208) 323-9752
NPI assigned
Jun 3, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 4271 NV
Physical Therapist 225100000X 7621 ID Primary

Addresses

Primary practice location

554 N Steelhead Way Ste 162
Boise, ID 83704-8388

Mailing address

1411 Falls Ave E Ste 401
Twin Falls, ID 83301-3455
Phone (082) 969-9945

Other practice location 1

9070 W.Cheyenne Ave
Suite 100
henderson, NV 89074
Phone (702) 818-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210924002564 ID Practitioner - Physical Therapist in Private Practice 9931521986 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1444 Falls Ave E
Twin Falls, ID 83301-3408
Phone (208) 736-2574

931 Ctr St W
Suite C
Kimberly, ID 83341-5326
Phone (208) 423-9999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7621IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Wright Physical Therapy Limited Partnership Physical Therapist CurrentSince Sep 7, 2021 Accepting new patients
Wright Physical Therapy Limited Partnership Physical Therapist CurrentSince Sep 7, 2021 Accepting new patients

Locations

554 N Steelhead Way
Ste 162
Boise, ID 83704
Phone (208) 323-9747

931 Center St W
#C
Kimberly, ID 83341
Phone (208) 423-9999

1444 Falls Ave E
Twin Falls, ID 83301
Phone (208) 736-2574

1411 Falls Ave E
Ste 401
Twin Falls, ID 83301
Phone (208) 969-9945

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1591142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630281600000",
    "number": "1194349381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 FALLS AVE E STE 401",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833013455",
            "telephone_number": "082-969-9945",
            "fax_number": "208-944-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "554 N STEELHEAD WAY STE 162",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048388",
            "telephone_number": "208-323-9747",
            "fax_number": "208-323-9752"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9070 W.Cheyenne Ave",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "henderson",
            "state": "NV",
            "postal_code": "89074",
            "country_code": "US",
            "telephone_number": "702-818-5000",
            "fax_number": "702-818-5001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULFORD",
        "first_name": "SAMUEL",
        "middle_name": "TAYLOR",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-03",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "4271",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "7621",
            "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 Aug 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.