Ryan Patrick McCormick, P.T., D.P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7649 Issued in ID

Practice address

1945 Hiland Ave
Burley, ID 83318-2714

Phone

(208) 647-0024

Fax

(208) 647-0239

NPI assigned

Jun 21, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1277078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1285955583",
    "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": "208-969-9945",
            "fax_number": "208-944-0488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1945 HILAND AVE",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182714",
            "telephone_number": "208-647-0024",
            "fax_number": "208-647-0239"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8885 Highway 34 S",
            "address_purpose": "LOCATION",
            "city": "Quinlan",
            "state": "TX",
            "postal_code": "754749434",
            "country_code": "US",
            "telephone_number": "903-356-4100",
            "fax_number": "903-356-4140",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMICK",
        "first_name": "RYAN",
        "middle_name": "PATRICK",
        "credential": "P.T., D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-21",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1204093",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "7649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "165348701",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT25574",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cody William Matthews, NURSE PRACTITIONER
• Michael B Matthews
• Alan Maxwell, RPH
• Lorie P May, COTA/L
• Taylor McAllister, PA-C
• Mary Irene McGinnis, LMSW
• Debra Leanor McKnight
• Brent Lee McMillan, P.T.
• Medical Lab Service
• Clea K. Mefford, RN MSN CRNP

• Physical Therapist in Burley, ID
• Providers in Burley, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.