Active NPI
Tommy Jo Brunelle, P.T., D.P.T.
- Physical Therapist
- Boise, ID
National Provider Identifier
1730356510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-374
- Practice address
- 1673 W Shoreline Dr
Ste 230
Boise, ID 83702-6750 - Phone
- (208) 343-4700
- Fax
- (208) 343-4706
- NPI assigned
- May 12, 2008
- Last updated
- May 18, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-374 | ID | Primary |
Addresses
Primary practice location
1673 W Shoreline Dr
Ste 230
Boise, ID 83702-6750
Mailing address
1673 W Shoreline Dr
Ste 230
Boise, ID 83702-6750
Phone (208) 343-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TD785 | Other | ID | BLUE CROSS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Action Therapy | Physical Therapist | Past | Accepting new patients |
| Intermountain Orthopaedic PLLC | Past | Accepting new patients | |
| Action Therapy, P.C. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Orthopaedic Surgery Physician
- Boise, ID
- NPI 1336392448
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210550400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431907200000",
"number": "1730356510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1673 W SHORELINE DR",
"address_2": "STE 230",
"city": "BOISE",
"state": "ID",
"postal_code": "837026750",
"telephone_number": "208-343-4700",
"fax_number": "208-343-4706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1673 W SHORELINE DR",
"address_2": "STE 230",
"city": "BOISE",
"state": "ID",
"postal_code": "837026750",
"telephone_number": "208-343-4700",
"fax_number": "208-343-4706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNELLE",
"first_name": "TOMMY",
"middle_name": "JO",
"credential": "P.T., D.P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-12",
"last_updated": "2015-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-374",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "TD785",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}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 May 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.