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Individual provider Active NPI Physical Therapy Assistant · Middleton, ID

NPI 1255280905 · NPPES record last updated Jan 26, 2026

Key facts

NPI
1255280905
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapy Assistant 225200000X
License
PTA-7365 (ID)
Practice address
533 S Middleton Rd Ste 100
Middleton, ID 83644-6014
Phone
(208) 585-6566
Fax
(208) 585-6768
NPI assigned
Jan 26, 2026
Sex
Male
Sole proprietor
No

Organizations & group practices 1

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.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
PTA-7365IDMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Physical Therapy P C Past
since Nov 1, 2017
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA-7365 ID Yes

Addresses

Primary practice location

533 S Middleton Rd Ste 100
Middleton, ID 83644-6014

Mailing address

533 S Middleton Rd Ste 100
Middleton, ID 83644-6014
Phone (208) 585-6566

Other providers in Middleton, ID

All providers in Middleton, ID · Physical Therapy Assistant in Idaho

Sources for this page

Verify at the official NPI Registry.