Joshua Tree Physical Therapy PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

PT1457 Issued in ID

Legal business name

JOSHUA TREE PHYSICAL THERAPY PLLC

Practice address

8300 N Wayne Dr
Hayden, ID 83835-6027

Phone

(208) 772-9774

Fax

(208) 772-9564

NPI assigned

Aug 14, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kevin John Sgroi, P.T.NPI 1770678484

Title

Owner-Operator

Phone

(208) 772-9774

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Affordable Excellence in Physical Therapy Former legal business name

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin John Sgroi, P.T.

  • Physical Therapist
  • Hayden, ID
  • NPI 1770678484
  Medicare reassignment Care Compare group NPD Authorized official
• Karen L Lee, MPT

  • Physical Therapist
  • Hayden, ID
  • NPI 1093725780
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1477566941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8300 N WAYNE DR",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838356027",
            "telephone_number": "208-772-9774",
            "fax_number": "208-772-9564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 N WAYNE DR",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838356027",
            "telephone_number": "208-772-9774",
            "fax_number": "208-772-9564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSHUA TREE PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "SGROI",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER-OPERATOR",
        "authorized_official_telephone_number": "208-772-9774",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "ID",
            "license": "PT1457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807014300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affordable Excellence in Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Affordable Excellence in Physical Therapy",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Susan Johnson, RNFA
• Jennifer Alayne Jones
• Warren Jones, M.ED
• Josh Cochran 8382 PLLC
• Shaun K Joshi, MD
• Lucy Julien
• Richard H Justus, M.ED., BCBA
• Justin Thomas Kane, PT
• Cristy Kay, LCSW
• Susan E Keeley, LCSW

• Specialist in Hayden, ID
• Providers in Hayden, ID by specialty
• Specialist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 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.

Verify at the official NPI Registry.