Joshua Ross Greenwell, DPT
Individual provider Active NPI Physical Therapist · Burley, ID
NPI 1780239103 · NPPES record last updated Aug 2, 2019
Key facts
- NPI
- 1780239103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-6455 (ID)
- Practice address
- 1263 Bennett Ave Ste 2
Burley, ID 83318-4906 - Phone
- (208) 678-1191
- NPI assigned
- Aug 2, 2019
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-6455 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Burley Physical Therapy and Rehabilitation | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-6455 | ID | Yes |
Addresses
Primary practice location
1263 Bennett Ave Ste 2
Burley, ID 83318-4906
Mailing address
1263 Bennett Ave Ste 2
Burley, ID 83318-4906
Phone (208) 678-1191
Other providers in Burley, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.