Active NPI
Jennifer Anne Wilson
- Physical Therapist
- Boise, ID
National Provider Identifier
1366607137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 1539
- Practice address
- 1001 S Hilton St
Boise, ID 83705-1925 - Phone
- (208) 345-4464
- Fax
- (208) 433-5398
- NPI assigned
- Jul 22, 2008
- Sex
- Female
- 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 1539 | ID | Primary |
Addresses
Primary practice location
1001 S Hilton St
Boise, ID 83705-1925
Mailing address
1017 N 20TH St
Boise, ID 83702-3208
Other names 1
- Jennifer Wilson Rosales
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
| License | State | Type | Specialty |
|---|---|---|---|
| PT 1539 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216684800000",
"number": "1366607137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1017 N 20TH ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837023208"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 S HILTON ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837051925",
"telephone_number": "208-345-4464",
"fax_number": "208-433-5398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JENNIFER",
"middle_name": "ANNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-22",
"last_updated": "2008-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT 1539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JENNIFER",
"last_name": "ROSALES",
"middle_name": "WILSON",
"code": "5",
"type": "Other Name"
}
]
}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 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.