Active NPI
Dean Cisco, DPT
- Physical Therapist
- Moscow, ID
National Provider Identifier
1972296994
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 7957
- Practice address
- 700 S Main St
Moscow, ID 83843-3056 - Phone
- (208) 882-4511
- NPI assigned
- May 26, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 64348 | OR | |
| Physical Therapist | 225100000X | 7957 | ID | Primary |
Addresses
Primary practice location
700 S Main St
Moscow, ID 83843-3056
Mailing address
448 Greensides PL
Moscow, ID 83843-5009
Phone (808) 312-7407
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7957 | ID | MD | Physical Therapist |
| 64348 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685059200000",
"number": "1972296994",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 GREENSIDES PL",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838435009",
"telephone_number": "808-312-7407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S MAIN ST",
"city": "MOSCOW",
"state": "ID",
"postal_code": "838433056",
"telephone_number": "208-882-4511"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CISCO",
"first_name": "DEAN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-05-26",
"last_updated": "2023-05-26",
"certification_date": "2023-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "64348",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "7957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Moscow, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.