Boost Ventures PLLC
Organization Active NPI Physical Therapist · Rexburg, ID
NPI 1740883172 · NPPES record last updated Nov 18, 2020
Key facts
- NPI
- 1740883172
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- BOOST VENTURES PLLC
- Practice address
- 36 N 2ND W
Rexburg, ID 83440-1515 - Phone
- (208) 313-7569
- NPI assigned
- Nov 18, 2020
- Organization subpart
- No
Authorized official
- Name
- Blake Galbraith, DPT
- Title
- Owner
- Phone
- (208) 313-7569
Practitioners 1
-
Blake Lee Galbraith, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210204000687 | ID | Part B Supplier - Clinic/Group Practice | 7911311865 |
Receives reassigned benefits from 1 practitioner Practice locations: Rexburg, ID |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes |
Addresses
Primary practice location
36 N 2ND W
Rexburg, ID 83440-1515
Mailing address
36 N 2ND W
Rexburg, ID 83440-1515
Phone (208) 313-7569
Other names
- Boost Physical Therapy
Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.