Nicholas P Greenwell, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1359 Issued in ID

Practice address

1263 Bennett Ave
Suite 2
Burley, ID 83318-2666

Phone

(208) 678-1191

Fax

(208) 678-1214

NPI assigned

Dec 5, 2006

Last updated

Feb 10, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Burley Physical Therapy and Rehabilitation

  • Physical Therapy Clinic/Center
  • Burley, ID
  • NPI 1669530051
  NPD

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455062400000",
    "number": "1669530119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1263 BENNETT AVE",
            "address_2": "STE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833184906",
            "telephone_number": "208-678-1191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1263 BENNETT AVE",
            "address_2": "SUITE 2",
            "city": "BURLEY",
            "state": "ID",
            "postal_code": "833182666",
            "telephone_number": "208-678-1191",
            "fax_number": "208-678-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENWELL",
        "first_name": "NICHOLAS",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2016-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1359",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010009167",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "T5311",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805407400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexa Sanaa Gonzales, COTA
• Veronica Marie Gonzalez, MS
• Walter Maitland Graham, M.D.
• Tyson Darrell Greener, PA-C
• Joshua Ross Greenwell, DPT
• Ashley Guercio, CPM, LM
• Olivia NMN Gutierrez, CADC
• Hansen Chiropractic and Neurology Health Center P C
• Jennifer Barton Hansen, M.S.,CCC-SLP
• Lynn A Hansen, DC

• Physical Therapist in Burley, ID
• Providers in Burley, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; 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.