Individual provider Active NPI

Alyssa Thierer

  • Physical Therapy Assistant
  • Boise, ID
National Provider Identifier
1295306454
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
7467 Issued in ID
Practice address
960 S Broadway Ave Ste 200
Boise, ID 83706-3667
Phone
(208) 433-9211
NPI assigned
Jul 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 7467 ID Primary

Addresses

Primary practice location

960 S Broadway Ave Ste 200
Boise, ID 83706-3667

Mailing address

503 E 50TH St Unit 206
Garden City, ID 83714-1450
Phone (540) 878-0153

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Boise Direct

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
7467IDMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1295306454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 E 50TH ST UNIT 206",
            "city": "GARDEN CITY",
            "state": "ID",
            "postal_code": "837141450",
            "telephone_number": "540-878-0153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "960 S BROADWAY AVE STE 200",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837063667",
            "telephone_number": "208-433-9211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIERER",
        "first_name": "ALYSSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "ID",
            "license": "7467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Boise",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "960 S Broadway Ave Ste 200",
            "city": "Boise",
            "state": "ID",
            "country_code": "US",
            "postal_code": "837063667",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Jul 8, 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.