NPIMap

Organization Active NPI

Physical Therapy 180 LLC

Doing business as Physical Therapy 180

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1669696910
Registry record updated Jan 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PHYSICAL THERAPY 180 LLC
Doing business as
Physical Therapy 180
Practice address
5909 W State Street
Boise, ID 83703
Phone
(208) 343-7700
Fax
(208) 331-2591
NPI assigned
Apr 11, 2007
Last updated
Jan 17, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2019

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

Authorized official

Name
Mr. Cory Allen McKnight
Title
Owner
Phone
(208) 343-7700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

5909 W State Street
Boise, ID 83703

Mailing address

5909 W State Street
Boise, ID 83703
Phone (208) 343-7700

Other practice location 1

3919 E Overland Rd
Meridian, ID 83642-6710
Phone (208) 898-1468

Other identifiers 1

IdentifierTypeStateIssuer
808631800MedicaidID

Other names 1

  • Physical Therapy 180 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190605000354 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830422955 Receives reassigned benefits from 4 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Locations

380 E Parkcenter Blvd
Ste 200
Boise, ID 83706
Phone (208) 343-7700

2690 S Eagle Rd
#100
Meridian, ID 83642
Phone (208) 898-1468

Practitioners & affiliated clinicians

Practitioners 27

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.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547683200000",
    "number": "1669696910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5909 W STATE STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-343-7700",
            "fax_number": "208-331-2591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5909 W STATE STREET",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-343-7700",
            "fax_number": "208-331-2591"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3919 E Overland Rd",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836426710",
            "country_code": "US",
            "telephone_number": "208-898-1468",
            "fax_number": "208-331-2591",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICAL THERAPY 180 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2019-01-17",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "CORY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-343-7700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "808631800",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy 180",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Physical Therapy 180",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2019; 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.