Active NPI
Peggy Goodman, P.T.
- Physical Therapist
- Rupert, ID
National Provider Identifier
1740680404
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-253
- Practice address
- 610 18TH St
Rupert, ID 83350-1027 - Phone
- (208) 431-3444
- NPI assigned
- Sep 1, 2014
- Last updated
- Sep 1, 2014
- 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-253 | ID | Primary |
Addresses
Primary practice location
610 18TH St
Rupert, ID 83350-1027
Mailing address
610 18TH St
Rupert, ID 83350-1027
Phone (208) 431-3444
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 |
|---|---|---|---|
| PT-253 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409529600000",
"number": "1740680404",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "610 18TH ST",
"city": "RUPERT",
"state": "ID",
"postal_code": "833501027",
"telephone_number": "208-431-3444"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 18TH ST",
"city": "RUPERT",
"state": "ID",
"postal_code": "833501027",
"telephone_number": "208-431-3444"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "PEGGY",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-01",
"last_updated": "2014-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-253",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rupert, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.