| Nickalus Shane Davis, PT | |
|
1010 S Allante Pl Ste 101, Boise, ID 83709-1660 | |
| (208) 370-5166 | |
| Not Available |
| Full Name | Nickalus Shane Davis |
|---|---|
| Gender | Male |
| Speciality | Physical Therapist |
| Location | 1010 S Allante Pl Ste 101, Boise, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336615749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | PT-5619 (Idaho) | Primary |
| Provider Name | Mcmartin Llc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1932875531 PECOS PAC ID: 2769880012 Enrollment ID: O20211018001290 |
| Mailing Address | Practice Location Address |
|---|---|
| Nickalus Shane Davis, PT 1010 S Allante Pl Ste 101, Boise, ID 83709-1660 Ph: (208) 370-5166 | Nickalus Shane Davis, PT 1010 S Allante Pl Ste 101, Boise, ID 83709-1660 Ph: (208) 370-5166 |
Mrs. Dianne Denise Nelson, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1130 Allumbaugh St, Boise, ID 83704 Phone: 208-854-8517 | |
Peter H Kolb, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 901 N Curtis Rd Ste 204, Boise, ID 83706 Phone: 208-367-3315 Fax: 208-367-2674 | |
Melissa Pirtle, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 703 S Americana Blvd, Suite 130, Boise, ID 83702 Phone: 208-706-7530 Fax: 208-706-7531 | |
Kyle Aaron Holbrook, PT, DPT, NCS Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 600 N Robbins Rd, Boise, ID 83702 Phone: 208-489-4444 | |
Rebecca Wensel, P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 190 E Bannock St, Boise, ID 83712 Phone: 208-381-2138 | |
Bridget Gilbertson, PT, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2931 N Maywood Ave, Boise, ID 83704 Phone: 385-498-1740 | |
Idaho Physical Therapy Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 1175 E Parkcenter Blvd, Ste 101, Boise, ID 83706 Phone: 208-367-1010 |