Individual provider Active NPI

Makena Mueller, PT, DPT, ATC

  • Physical Therapist
  • Eagle, ID
National Provider Identifier
1720640998
Registry record updated Feb 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
775 S Rivershore LN Ste 220
Eagle, ID 83616-5783
Phone
(208) 629-1030
NPI assigned
Jul 8, 2019
Last updated
Feb 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 27, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary
Athletic Trainer 2255A2300X NU

Addresses

Primary practice location

775 S Rivershore LN Ste 220
Eagle, ID 83616-5783

Mailing address

2717 W Bannock St
Boise, ID 83702-4759
Phone (719) 432-6943

Other practice location 1

320 S Main St
Olivet, MI 49076-9724
Phone (269) 749-7635

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911002774 ID Practitioner - Physical Therapist in Private Practice 0840730362 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Treasure Valley Pelvic Health LLCGroup PAC ID 4789929431, 9 clinicians

Practice addresses (Care Compare)

2717 W Bannock St
Suite 100
Boise, ID 83702-4758
Phone (208) 629-1030

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Treasure Valley Pelvic Health, LLC Physical Therapist CurrentSince Sep 16, 2024 Accepting new patients

Locations

2717 W Bannock St
Ste 100
Boise, ID 83702
Phone (208) 629-1030

775 S Rivershore Ln
Ste 220
Eagle, ID 83616
Phone (208) 435-8662

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1562544000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740614400000",
    "number": "1720640998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2717 W BANNOCK ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024759",
            "telephone_number": "719-432-6943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 S RIVERSHORE LN STE 220",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165783",
            "telephone_number": "208-629-1030"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "320 S Main St",
            "address_purpose": "LOCATION",
            "city": "Olivet",
            "state": "MI",
            "postal_code": "490769724",
            "country_code": "US",
            "telephone_number": "269-749-7635",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUELLER",
        "first_name": "MAKENA",
        "credential": "PT, DPT, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-08",
        "last_updated": "2025-02-27",
        "certification_date": "2025-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagle, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.