Active NPI
Caroline Brinson Bush, PTA
- Physical Therapy Assistant
- Boise, ID
National Provider Identifier
1730756917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA-7147
- Practice address
- 960 S Broadway Ave
Boise, ID 83706-3600 - Phone
- (208) 433-9211
- NPI assigned
- Jun 7, 2021
- Sex
- Female
- 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 Therapy Assistant | 225200000X | PTA-7147 | ID | Primary |
Addresses
Primary practice location
960 S Broadway Ave
Boise, ID 83706-3600
Mailing address
6243 S Wayland Way
Meridian, ID 83642-5711
Phone (901) 786-2761
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA-7147 | Medicaid | ID |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-7147 | ID | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623024000000",
"number": "1730756917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6243 S WAYLAND WAY",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836425711",
"telephone_number": "901-786-2761"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "960 S BROADWAY AVE",
"city": "BOISE",
"state": "ID",
"postal_code": "837063600",
"telephone_number": "208-433-9211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSH",
"first_name": "CAROLINE",
"middle_name": "BRINSON",
"name_prefix": "Miss",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-07",
"last_updated": "2021-06-07",
"certification_date": "2021-06-07",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA-7147",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PTA-7147",
"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 Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.