Idaho Direct Physical Therapy, PLLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

IDAHO DIRECT PHYSICAL THERAPY, PLLC

Practice address

1559 N Stevens Dr Apt B
Idaho Falls, ID 83401-3947

Phone

(815) 545-3996

NPI assigned

Nov 19, 2020

Last updated

Nov 19, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler J Burke, DPTNPI 1427464502

Title

Owner

Phone

(815) 545-3996

Specialties & licenses 1

Addresses

Practitioners 1

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.

• Tyler Burke, DPT

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1427464502
  NPD Authorized official

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1518560671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1559 N STEVENS DR APT B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013947",
            "telephone_number": "815-545-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1559 N STEVENS DR APT B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834013947",
            "telephone_number": "815-545-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO DIRECT PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-19",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "BURKE",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-545-3996",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Idaho Dept of Health & Welfare Esc Region 7
• Idaho Dept of Health & Welfare Itp Region 7
• Idaho Dept of Health & Welfare Region 7 Amh PSR If
• Idaho Dept of Health & Welfare Region 7 CMH Clinic If
• Idaho Dept of Health & Welfare Region 7 CMH PSR If
• Idaho Eye Center PA
• Idaho Eye Center PA
• Idaho Eye Pros Idaho Falls LLC (Eye Pros)
• Idaho Falls Arthritis Clinic PC
• Idaho Falls ASC

• Physical Therapy Clinic/Center in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapy Clinic/Center in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.