NPIMap

Organization Active NPI

Dupont Wellness PLLC

  • Physical Therapy Clinic/Center
  • Boise, ID
National Provider Identifier
1861254278
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
DUPONT WELLNESS PLLC
Practice address
1460 E Shenandoah Dr
Boise, ID 83712-6657
Phone
(208) 570-3004
Fax
(208) 252-6297
NPI assigned
Jan 30, 2024
Last updated
Apr 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

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

Authorized official

Name
Dr. Corey Dupont, PTNPI 1639334279
Title
Owner, Physical Therapist
Phone
(208) 570-3004

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Physical Therapist 225100000X NU

Addresses

Primary practice location

1460 E Shenandoah Dr
Boise, ID 83712-6657

Mailing address

1460 E Shenandoah Dr
Boise, ID 83712-6657
Phone (208) 570-3004

Other practice location 1

1625 W State St
Boise, ID 83702-4002
Phone (208) 570-3004

Other names 1

  • DuPont Wellness Group, PLLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240314001400 ID Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8426494238 Receives reassigned benefits from 2 practitioners
Practice locations: Boise, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

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": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1861254278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1460 E SHENANDOAH DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126657",
            "telephone_number": "208-570-3004",
            "fax_number": "208-252-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1460 E SHENANDOAH DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837126657",
            "telephone_number": "208-570-3004",
            "fax_number": "208-252-6297"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1625 W State St",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837024002",
            "country_code": "US",
            "telephone_number": "208-570-3004",
            "fax_number": "208-439-7657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DUPONT WELLNESS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-26",
        "status": "A",
        "authorized_official_last_name": "DUPONT",
        "authorized_official_first_name": "COREY",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-570-3004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DuPont Wellness Group, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 26, 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.