208 Physical Therapy LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

208 PHYSICAL THERAPY LLC

Practice address

1120 Stocks Ave Ste C
Rexburg, ID 83440-3590

Phone

(208) 261-2123

NPI assigned

Oct 6, 2022

Last updated

Feb 22, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tyrel Nelson, PT, DPTNPI 1477045581

Title

Owner

Phone

(208) 201-0365

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 1

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.

• Tyrel Nelson, PT

  • Physical Therapist
  • Rexburg, ID
  • NPI 1477045581
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677024000000",
    "number": "1851016356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 STOCKS AVE STE C",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834403590",
            "telephone_number": "208-261-2123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "208 PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-06",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "TYREL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-201-0365",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "1477045581",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://pteverywhere.com",
            "affiliation": "N",
            "endpointDescription": "electronic EMR",
            "address_1": "267 W 4650 N",
            "city": "Rexburg",
            "state": "ID",
            "country_code": "US",
            "postal_code": "834403206",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Orthopedic Physical Therapist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Orthopedic Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2023; 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.