Active NPI
David Nels Branvold, DPT
- Physical Therapist
- Twin Falls, ID
National Provider Identifier
1265787196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-3093
- Practice address
- 801 Pole Line Rd W
Twin Falls, ID 83301-5810 - Phone
- (208) 814-2495
- NPI assigned
- Jul 17, 2012
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-3093 | ID | Primary |
Addresses
Primary practice location
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Mailing address
801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 814-2495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265787196 | Medicaid | ID |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-3093 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342483200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518393600000",
"number": "1265787196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 POLE LINE RD W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015810",
"telephone_number": "208-814-2495"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 POLE LINE RD W",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015810",
"telephone_number": "208-814-2495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANVOLD",
"first_name": "DAVID",
"middle_name": "NELS",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-17",
"last_updated": "2018-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-3093",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1265787196",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.