Brace Place LTD

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BRACE PLACE LTD

Practice address

1033 W Quinn Rd
Pocatello, ID 83202-2425

Phone

(208) 234-4579

Fax

(208) 233-4887

NPI assigned

Oct 23, 2006

Last updated

Mar 23, 2010By 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

Dan R Desfosses, DPT

Title

Owner

Phone

(208) 234-4579

Specialties & licenses 1

Addresses

Other identifiers 2

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.

• C Ric Benedetti, DPT

  • Physical Therapist
  • Pocatello, ID
  • NPI 1427147784
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269302400000",
    "number": "1619050440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2844",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832062844",
            "telephone_number": "208-234-4579",
            "fax_number": "208-233-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 W QUINN RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022425",
            "telephone_number": "208-234-4579",
            "fax_number": "208-233-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRACE PLACE LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2010-03-23",
        "status": "A",
        "authorized_official_last_name": "DESFOSSES",
        "authorized_official_first_name": "DAN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-234-4579",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010014433",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "8402D",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Colten Boyd, DNP
• Kraig Boyd, LPC
• Travis Boyer, D.M.D.
• Julia Boyle, PHARMD
• Renee Lynn Bozorg-Omid, LPC
• Andrew Bradbury, MD
• Melissa Bradley, LMT
• Mendi Ann Bradley, LMT
• Branch Management LLC
• Branch Management LLC

• Durable Medical Equipment & Medical Supplies in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Durable Medical Equipment & Medical Supplies in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2010; 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.