Individual provider Active NPI

Henry Liao

  • Physical Therapist
  • Boise, ID
National Provider Identifier
1790640167
Registry record updated Dec 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5671484 Issued in ID
Practice address
12072 W McMillan Rd
Boise, ID 83713-2462
Phone
(208) 939-0533
Fax
(208) 939-3341
NPI assigned
Dec 18, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5671484 ID Primary

Addresses

Primary practice location

12072 W McMillan Rd
Boise, ID 83713-2462

Mailing address

4721 N Tattenham Way
Boise, ID 83713-2529
Phone (208) 939-0533

Other practice location 1

3040 N Five Mile Rd
Boise, ID 83713-5234
Phone (208) 939-0533

Other practice location 2

2316 S Eagle Rd
Meridian, ID 83642-2665
Phone (208) 939-0533

Other practice location 3

1525 S Orchard St
Boise, ID 83705-2620
Phone (208) 939-0533

Other practice location 4

2915 N Cole Rd Ste 101
Boise, ID 83704-5917
Phone (208) 939-0533

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251231002612 ID Practitioner - Physical Therapist in Private Practice 4183110901 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
ZRJ IncGroup PAC ID 6507858172, 12 clinicians

Practice addresses (Care Compare)

3040 N Five Mile Rd
Boise, ID 83713-5234
Phone (208) 939-0533

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5671484IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
ZRJ Inc Physical Therapist CurrentSince Dec 18, 2025 Accepting new patients

Locations

12072 W McMillan Rd
Boise, ID 83713
Phone (208) 939-0533

2915 N Cole Rd
#101
Boise, ID 83704
Phone (208) 939-0533

3040 N Five Mile Rd
Boise, ID 83713
Phone (208) 252-6531

2316 S Eagle Rd
Meridian, ID 83642
Phone (208) 286-2707

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1766016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1790640167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4721 N TATTENHAM WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132529",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12072 W MCMILLAN RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132462",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3040 N Five Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837135234",
            "country_code": "US",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2316 S Eagle Rd",
            "address_purpose": "LOCATION",
            "city": "Meridian",
            "state": "ID",
            "postal_code": "836422665",
            "country_code": "US",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1525 S Orchard St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837052620",
            "country_code": "US",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2915 N Cole Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837045917",
            "country_code": "US",
            "telephone_number": "208-939-0533",
            "fax_number": "208-939-3341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIAO",
        "first_name": "HENRY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-12-18",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "5671484",
            "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 Dec 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.