Jeremy Thomas Pettinger, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1913 Issued in ID

Practice address

126 E Main St
Grangeville, ID 83530-2211

Phone

(208) 406-5195

NPI assigned

Mar 6, 2007

Last updated

Jul 8, 2007By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Preferred Physical Therapy, P.a.

  • Physical Therapy Clinic/Center
  • Grangeville, ID
  • NPI 1447389093
  Authorized official Same address or phone
• Mental Health Clinic of Idaho PLLC

  • Psychiatry Physician
  • Boise, ID
  • NPI 1215622048
  NPD
• Peregrine Physical Therapy LLC

  dba Physical Therapy 180

  • Physical Therapist
  • Boise, ID
  • NPI 1942128137
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700916087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 327",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835300327",
            "telephone_number": "208-406-5195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 E MAIN ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835302211",
            "telephone_number": "208-406-5195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINGER",
        "first_name": "JEREMY",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• North Star Phoenix Inc
• Opportunities Unlimited, Inc.
• Opportunities Unlimited, Inc.
• Alexandra Beth Palmer, RPH
• Bryan James Petersen, D.D.S.
• Nicolette Phillips, LCSW
• Preferred Physical Therapy, P.a.
• Quality Life Health Center Inc P S
• Benjamin Reeves, DPT
• Right at Home Care

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.