Active NPI
Jeremy A Mayo, DPT
- Physical Therapist
- Boise, ID
National Provider Identifier
1861622078
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT2557
- Practice address
- 5520 N Eagle Rd
Suite 102
Boise, ID 83713-2700 - Phone
- (208) 938-5255
- Fax
- (208) 938-5545
- NPI assigned
- Jul 22, 2009
- 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 | PT2557 | ID | Primary |
Addresses
Primary practice location
5520 N Eagle Rd
Suite 102
Boise, ID 83713-2700
Mailing address
2176 E Franklin Rd
Suite 100
Meridian, ID 83642-9024
Phone (208) 288-1155
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT2557 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peak Physical Therapy P C | Physical Therapist | Past | Accepting new patients |
| Rehabauthority, LLC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Boise, ID
- NPI 1073551560
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284422400000",
"number": "1861622078",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2176 E FRANKLIN RD",
"address_2": "SUITE 100",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836429024",
"telephone_number": "208-288-1155",
"fax_number": "208-461-4510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5520 N EAGLE RD",
"address_2": "SUITE 102",
"city": "BOISE",
"state": "ID",
"postal_code": "837132700",
"telephone_number": "208-938-5255",
"fax_number": "208-938-5545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAYO",
"first_name": "JEREMY",
"middle_name": "A",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-22",
"last_updated": "2010-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT2557",
"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 Sep 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.