Active NPI
Ethan Rayhorn, DPT
- Physical Therapist
- Boise, ID
National Provider Identifier
1831592963
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-3704
- Practice address
- 1501A E Shenandoah Dr.
Boise, ID 83712-6660 - Phone
- (906) 362-5002
- NPI assigned
- Oct 3, 2014
- Sex
- Male
- Sole proprietor
- No
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-3704 | ID | Primary |
Addresses
Primary practice location
1501A E Shenandoah Dr.
Boise, ID 83712-6660
Mailing address
1501A E Shenandoah Dr
Boise, ID 83712-6660
Phone (906) 362-5002
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-3704 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1412294400000",
"number": "1831592963",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501A E SHENANDOAH DR",
"city": "BOISE",
"state": "ID",
"postal_code": "837126660",
"telephone_number": "906-362-5002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501A E SHENANDOAH DR.",
"city": "BOISE",
"state": "ID",
"postal_code": "837126660",
"telephone_number": "906-362-5002"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAYHORN",
"first_name": "ETHAN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-03",
"last_updated": "2014-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-3704",
"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 Oct 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.