Active NPI
Jeffrey Bennett
- Physical Therapist
- Middleton, ID
National Provider Identifier
1730575648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4080
- Practice address
- 533 S Middleton Rd
Ste 100
Middleton, ID 83644-6013 - Phone
- (208) 585-6566
- Fax
- (208) 585-6768
- NPI assigned
- Apr 8, 2015
- Last updated
- Apr 8, 2015
- Sex
- Male
- Sole proprietor
- No
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 | PT4080 | ID | Primary |
Addresses
Primary practice location
533 S Middleton Rd
Ste 100
Middleton, ID 83644-6013
Mailing address
7550 W Emerald St
Boise, ID 83704-9015
Phone (208) 375-0666
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT4080 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McCall Physical Therapy, P.a. | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- McCall, ID
- NPI 1750454104
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1428451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428451200000",
"number": "1730575648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7550 W EMERALD ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837049015",
"telephone_number": "208-375-0666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "533 S MIDDLETON RD",
"address_2": "STE 100",
"city": "MIDDLETON",
"state": "ID",
"postal_code": "836446013",
"telephone_number": "208-585-6566",
"fax_number": "208-585-6768"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "JEFFREY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-08",
"last_updated": "2015-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT4080",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middleton, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.