NPIMap

Organization Active NPI

Physical Therapy Partners Nevada LLC

  • Physical Therapist
  • Reno, NV
National Provider Identifier
1407924178
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL THERAPY PARTNERS NEVADA LLC
Practice address
10775 Double R Blvd
100
Reno, NV 89521-8956
Phone
(775) 853-7475
Fax
(775) 853-2013
NPI assigned
Dec 1, 2006
Last updated
Dec 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Authorized official

Name
Mr. Boyd A Etter, PT, DIP. MDT, OCSNPI 1669460440
Title
Owner
Phone
(775) 853-7475

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)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

10775 Double R Blvd
100
Reno, NV 89521-8956

Mailing address

415 US Highway 95a S
C302
Fernley, NV 89408-9261
Phone (775) 575-1818

Other identifiers 2

IdentifierTypeStateIssuer
100505650MedicaidNV
V104480OtherNVMEDICARE PTAN

Other names 1

  • Soar Physical Therapy Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040914000912 NV Part B Supplier - Clinic/Group Practice 2860469350 Receives reassigned benefits from 6 practitioners
Practice locations: Fernley, NV; Reno, NV

National Provider Directory

National Provider Directory

Locations

415 US Highway 95A S
Ste 302
Fernley, NV 89408
Phone (775) 853-5839

415 US Highway 95A S
Ste C302
Fernley, NV 89408
Phone (775) 575-1818

10605 Double R Blvd
#200
Reno, NV 89521
Phone (775) 853-7475

10775 Double R Blvd
#100
Reno, NV 89521
Phone (775) 853-7475

10775 Double R Blvd
Ste 100
Reno, NV 89521
Phone (775) 853-7475

8725 Technology Way
Ste C2
Reno, NV 89521
Phone (775) 853-7475

3395 US Highway 50
Silver Springs, NV 89429

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1407924178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 US HIGHWAY 95A S",
            "address_2": "C302",
            "city": "FERNLEY",
            "state": "NV",
            "postal_code": "894089261",
            "telephone_number": "775-575-1818",
            "fax_number": "775-515-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10775 DOUBLE R BLVD",
            "address_2": "100",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218956",
            "telephone_number": "775-853-7475",
            "fax_number": "775-853-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY PARTNERS NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "ETTER",
        "authorized_official_first_name": "BOYD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "775-853-7475",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT, DIP. MDT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505650",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "V104480",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soar Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2011; 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.

Verify at the official NPI Registry.