Active NPI
Siddhivinayak, LLC
- Physical Therapist
- Meridian, ID
National Provider Identifier
1336847342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- SIDDHIVINAYAK, LLC
- Practice address
- 3645 E Overland Rd
Meridian, ID 83642-6751 - Phone
- (208) 703-4950
- NPI assigned
- Feb 20, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gunjan D Patel, PT
- Title
- President
- Phone
- (208) 703-4950
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
3645 E Overland Rd
Meridian, ID 83642-6751
Mailing address
5457 S Ashcroft Way
Meridian, ID 83642-6866
Phone (208) 703-4950
Other names 1
- Fyzical Therapy & Balance Centers
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230801003370 | ID | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 7911368386 |
Receives reassigned benefits from 4 practitioners Practice locations: Nampa, ID; Meridian, ID |
National Provider Directory
National Provider DirectoryLocations
3645 E Overland Rd
Meridian, ID 83642
Phone (208) 703-4950
421 Caldwell Blvd
Ste 106
Nampa, ID 83651
Phone (208) 450-5577
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676851200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1676851200000",
"number": "1336847342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5457 S ASHCROFT WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836426866",
"telephone_number": "208-703-4950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3645 E OVERLAND RD",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836426751",
"telephone_number": "208-703-4950"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SIDDHIVINAYAK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-02-20",
"last_updated": "2023-02-20",
"certification_date": "2023-02-20",
"status": "A",
"authorized_official_last_name": "PATEL",
"authorized_official_first_name": "GUNJAN",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "208-703-4950",
"authorized_official_credential": "PT"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fyzical Therapy & Balance Centers",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.