Active NPI
Brady Gooch
- Physical Therapist
- Meridian, ID
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6171077
- Practice address
- 1450 E Fairview Ave # 201
Meridian, ID 83642-1819 - Phone
- (208) 887-6757
- NPI assigned
- Aug 11, 2025
- 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 | 6171077 | ID | Primary |
Addresses
Primary practice location
1450 E Fairview Ave # 201
Meridian, ID 83642-1819
Mailing address
3639 S Gekeler LN Apt 83
Boise, ID 83706-6456
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1450 E Fairview Ave
Suite 201
Meridian, ID 83642-1819
Phone (208) 887-6757
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6171077 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Land Rehabilitation LLC | Physical Therapist | Current | Accepting new patients |
| Registered Physical Therapists LLC | Past | Accepting new patients |
Locations
8727 W Ardene St
Ste 102G
Boise, ID 83709
Phone (208) 322-6200
1450 E Fairview Ave
#201
Meridian, ID 83642
Phone (208) 887-6757
1800 Flandro Dr
Ste 190
Pocatello, ID 83202
Phone (208) 233-2248
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 Therapy Clinic/Center
- Sandy, UT
- NPI 1477582633
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754870400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754870400000",
"number": "1942185624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3639 S GEKELER LN APT 83",
"city": "BOISE",
"state": "ID",
"postal_code": "837066456"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1450 E FAIRVIEW AVE # 201",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836421819",
"telephone_number": "208-887-6757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOOCH",
"first_name": "BRADY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-08-11",
"last_updated": "2025-08-11",
"certification_date": "2025-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "6171077",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Meridian, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.