NPIMap

Organization Active NPI

Restore Physical Therapy PC

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1790236511
Registry record updated Jan 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-1804 Issued in ID
Legal business name
RESTORE PHYSICAL THERAPY PC
Practice address
5418 N Eagle Rd
Suite 170
Boise, ID 83713-0998
Phone
(208) 501-8264
Fax
(208) 514-1558
NPI assigned
Oct 17, 2016
Last updated
Jan 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Sarah Graham, P.T.NPI 1386758464
Title
Owner
Phone
(208) 501-8264

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-1804 ID Primary

Addresses

Primary practice location

5418 N Eagle Rd
Suite 170
Boise, ID 83713-0998

Mailing address

5418 N Eagle Rd
Suite 170
Boise, ID 83713-0998
Phone (208) 939-3332

Other practice location 1

16211 N Brinson St Ste 220
Nampa, ID 83687-5525
Phone (208) 936-2522

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170207000720 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143503607 Receives reassigned benefits from 9 practitioners
Practice locations: Boise, ID; Nampa, ID

National Provider Directory

National Provider Directory

Locations

1175 E Parkcenter Blvd
Ste 104A
Boise, ID 83706
Phone (208) 807-2486

5418 N Eagle Rd
Ste 170
Boise, ID 83713
Phone (208) 376-3781

670 E Riverpark Ln
Ste 400
Boise, ID 83706
Phone (208) 807-2486

16211 N Brinson St
Spc 100
Nampa, ID 83687
Phone (208) 908-8540

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1476662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704844800000",
    "number": "1790236511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5418 N EAGLE RD",
            "address_2": "SUITE 170",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130998",
            "telephone_number": "208-939-3332",
            "fax_number": "208-939-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5418 N EAGLE RD",
            "address_2": "SUITE 170",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837130998",
            "telephone_number": "208-501-8264",
            "fax_number": "208-514-1558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16211 N Brinson St Ste 220",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836875525",
            "country_code": "US",
            "telephone_number": "208-936-2522",
            "fax_number": "208-936-2523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RESTORE PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-17",
        "last_updated": "2024-01-10",
        "certification_date": "2024-01-10",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-501-8264",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1804",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.