Kevin Douglas Racine, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-6627 Issued in ID

Practice address

1618 S Millenium Way Ste 210
Meridian, ID 83642-6457

Phone

(208) 884-4647

Fax

(208) 884-8984

NPI assigned

Feb 13, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Foothills Physical Therapy PA

  • Specialist
  • Meridian, ID
  • NPI 1851457675
  Medicare reassignment NPD

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1962035469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "645 E STATE ST STE 101",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165915",
            "telephone_number": "208-939-9594",
            "fax_number": "208-939-9828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1618 S MILLENIUM WAY STE 210",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836426457",
            "telephone_number": "208-884-4647",
            "fax_number": "208-884-8984"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "645 E State St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Eagle",
            "state": "ID",
            "postal_code": "836165915",
            "country_code": "US",
            "telephone_number": "208-939-9594",
            "fax_number": "208-939-9828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RACINE",
        "first_name": "KEVIN",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-02-13",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-6627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara E Quattrone, MD
• Chad William Queen, DC
• Margarita Quiroz, PHARMACY TECHNICIAN
• R2MS Wellness
• Daniel Edward Race, D.C.
• Paige Rackham
• Jacob Radil, PA-C
• Cyndy Eldredge Radovich, MMA
• Hala Gamal Rafla, MPAS
• Jacqlyn Raivo, RDN

• Physical Therapist in Meridian, ID
• Providers in Meridian, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2020; 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.