Active NPI
Jesse Castillo, DPT
- Physical Therapist
- Rexburg, ID
National Provider Identifier
1760267371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-8804
- Practice address
- 217 N 2ND E
Rexburg, ID 83440-1621 - Phone
- (208) 359-6127
- Fax
- (208) 359-9479
- NPI assigned
- Aug 30, 2023
- Last updated
- Aug 30, 2023
- Sex
- Male
- 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-8804 | ID | Primary |
Addresses
Primary practice location
217 N 2ND E
Rexburg, ID 83440-1621
Mailing address
217 N 2ND E
Rexburg, ID 83440-1621
Phone (208) 359-6127
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Medicine and Rehabilitation
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
- Group practices
Practice addresses (Care Compare)
217 N 2ND
Rexburg, ID 83440-1621
Phone (208) 359-6127
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-8804 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spine and Sport Pysical Therapy PC | Physical Therapist | Current | Accepting new patients |
Locations
217 N 2nd E
Rexburg, ID 83440
Phone (208) 359-6127
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
- Rexburg, ID
- NPI 1992975825
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693353600000",
"number": "1760267371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 N 2ND E",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401621",
"telephone_number": "208-359-6127",
"fax_number": "208-359-9479"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 N 2ND E",
"city": "REXBURG",
"state": "ID",
"postal_code": "834401621",
"telephone_number": "208-359-6127",
"fax_number": "208-359-9479"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CASTILLO",
"first_name": "JESSE",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-08-30",
"last_updated": "2023-08-30",
"certification_date": "2023-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-8804",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rexburg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.