|
| |
|
2005 12th Ave Rd, Nampa, ID 83686-6311 | |
| (208) 463-0022 | |
| (208) 463-0031 |
| Full Name | |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 2005 12th Ave Rd, Nampa, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427103837 | NPI | - | NPPES |
| 002689100 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | (* (Not Available)) | Primary |
| Provider Name | Ryan P Haskell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003069725 PECOS PAC ID: 4688569320 Enrollment ID: I20121218000124 |
| Provider Name | Michael G Lemmon |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1790154128 PECOS PAC ID: 3678882040 Enrollment ID: I20151026001692 |
| Provider Name | Samuel Timothy Hetherington |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1093325979 PECOS PAC ID: 1658797519 Enrollment ID: I20200821002817 |
| Provider Name | Tristen I Keller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144897414 PECOS PAC ID: 0345640827 Enrollment ID: I20210621003234 |
| Provider Name | Tyson Daniel Cook |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1033583117 PECOS PAC ID: 1759775703 Enrollment ID: I20220308001886 |
| Mailing Address | Practice Location Address |
|---|---|
2005 12th Ave Rd, Nampa, ID 83686-6311 Ph: (208) 463-0022 | 2005 12th Ave Rd, Nampa, ID 83686-6311 Ph: (208) 463-0022 |
Nathan Ira Allen, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2635 Caldwell Blvd, Ste. B, Nampa, ID 83651 Phone: 208-442-0577 Fax: 208-442-7455 | |
Peter James Rowley, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 337 W Iowa Ave, Nampa, ID 83686 Phone: 208-467-7889 Fax: 208-467-7800 | |
Carmen M Schmidt, PT Physical Therapist Medicare: Medicare Enrolled Practice Location: 220 10th Ave S, Nampa, ID 83651 Phone: 208-489-5950 | |
Mr. James Richard Teater, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 4300 E Flamingo Ave, Nampa, ID 83687 Phone: 208-205-5059 | |
Derek Matthew Wood, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 172 2nd St S, Nampa, ID 83651 Phone: 208-385-3620 | |
Tyler Powell, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 16816 N Marketplace Blvd, Nampa, ID 83687 Phone: 208-461-9593 Fax: 208-369-9272 | |