Individual provider Active NPI

William Berkeley Cleary, DPT

  • Physical Therapist
  • Murray, UT
National Provider Identifier
1811636319
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-8025 Issued in ID
Practice address
746 E Winchester St Ste G10
Murray, UT 84107-8532
Phone
(801) 981-5977
NPI assigned
Jun 2, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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 PT-8025 ID Primary

Addresses

Primary practice location

746 E Winchester St Ste G10
Murray, UT 84107-8532

Mailing address

616 S 10TH Ave
Pocatello, ID 83201-4806
Phone (208) 705-4740

Other practice location 1

820 W Chubbuck Rd
Chubbuck, ID 83202-2933
Phone (208) 240-6017

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220722002790 ID Practitioner - Physical Therapist in Private Practice 1052792900 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT-8025IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Key Performance and Wellness LLC Physical Therapist CurrentSince Aug 13, 2024 Accepting new patients
Go PT Physical Therapist CurrentSince Nov 13, 2023 Accepting new patients
High Desert Physical Therapy LLC Physical Therapist CurrentSince Jun 2, 2022 Accepting new patients

Locations

820 W Chubbuck Rd
Chubbuck, ID 83202
Phone (208) 240-6017

202 S 5th Ave
Pocatello, ID 83201
Phone (208) 251-5997

746 E Winchester St
Ste G10
Salt Lake City, UT 84107
Phone (801) 293-1199

8789 S Redwood Rd
Ste 100
West Jordan, UT 84088
Phone (801) 792-9189

Organizations & group practices 3

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": "1654128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1811636319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "616 S 10TH AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014806",
            "telephone_number": "208-705-4740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "746 E WINCHESTER ST STE G10",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841078532",
            "telephone_number": "801-981-5977"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "820 W Chubbuck Rd",
            "address_purpose": "LOCATION",
            "city": "Chubbuck",
            "state": "ID",
            "postal_code": "832022933",
            "country_code": "US",
            "telephone_number": "208-240-6017",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLEARY",
        "first_name": "WILLIAM",
        "middle_name": "BERKELEY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-02",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-8025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.