Active NPI
Brandon Phoenix Kallgren, DPT
- Physical Therapist
- Idaho Falls, ID
National Provider Identifier
1265317341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5171576
- Practice address
- 3155 Channing Way Ste D
Idaho Falls, ID 83404-7875 - Phone
- (208) 973-4170
- NPI assigned
- Aug 8, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5171576 | ID | Primary |
Addresses
Primary practice location
3155 Channing Way Ste D
Idaho Falls, ID 83404-7875
Mailing address
198 Whittier St
Idaho Falls, ID 83402-2207
Phone (208) 360-6955
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3155 Channing Way
Suite D
Idaho Falls, ID 83404-7875
Phone (208) 973-4170
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5171576 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pick PT Ammon LLC | Physical Therapist | Current | Accepting new patients |
| Rehabauthority, LLC | Physical Therapist | Current | Accepting new patients |
Locations
3155 Channing Way
Ste D
Idaho Falls, ID 83404
Phone (208) 552-2700
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": "1754611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754611200000",
"number": "1265317341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "198 WHITTIER ST",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834022207",
"telephone_number": "208-360-6955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3155 CHANNING WAY STE D",
"city": "IDAHO FALLS",
"state": "ID",
"postal_code": "834047875",
"telephone_number": "208-973-4170"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLGREN",
"first_name": "BRANDON",
"middle_name": "PHOENIX",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-08-08",
"last_updated": "2025-08-08",
"certification_date": "2025-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "5171576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Idaho Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.