| Northstar Physical Therapy | |
|
9652 W State Street, Star, ID 83669-5858 | |
| (208) 286-0766 | |
| (208) 286-0768 |
| Full Name | Northstar Physical Therapy |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 9652 W State Street, Star, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043380769 | NPI | - | NPPES |
| 80694000 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 1136 (Idaho) | Primary |
| 225100000X | Physical Therapist | RPT1371 (Idaho) | Secondary |
| 225100000X | Physical Therapist | RPT1136 (Idaho) | Secondary |
| Provider Name | Judianne K Nichols |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184794810 PECOS PAC ID: 1153300884 Enrollment ID: I20040720001582 |
| Provider Name | Brian D Nichols |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679679088 PECOS PAC ID: 0143209874 Enrollment ID: I20040720001598 |
| Provider Name | Jami J Whiles |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1558350587 PECOS PAC ID: 5991749491 Enrollment ID: I20050615000775 |
| Provider Name | Rosemary C Howell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194033514 PECOS PAC ID: 0547453276 Enrollment ID: I20101026000503 |
| 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 | Brian M Holgate |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1629312269 PECOS PAC ID: 5496908899 Enrollment ID: I20130115000455 |
| Provider Name | Ann A Fujimoto-distefano |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588739957 PECOS PAC ID: 4587554878 Enrollment ID: I20210924001424 |
| Provider Name | Kimberly Mazzella |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1730110982 PECOS PAC ID: 6002811387 Enrollment ID: I20220930002315 |
| Mailing Address | Practice Location Address |
|---|---|
| Northstar Physical Therapy 9652 W State Street, Star, ID 83669-5858 Ph: (208) 286-0766 | Northstar Physical Therapy 9652 W State Street, Star, ID 83669-5858 Ph: (208) 286-0766 |
Mrs. Danielle-noelle D. Wuerfel, DPT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 2101 N Cardigan Ave, Star, ID 83669 Phone: 269-277-1224 | |
Krysia Kristine Rousseau, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 704 N Nebula Ct, Star, ID 83669 Phone: 208-703-9824 | |
Mrs. Judianne King Nichols, MPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 9652 W State Street, Star, ID 83669 Phone: 208-286-0766 Fax: 208-286-0768 | |
Lindsey E. Decloss, M.S.P.T. Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 9652 W State St, Star, ID 83669 Phone: 208-286-0766 | |
Clayton Towner Shaw, P.T. Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 64 S Star Rd, Star, ID 83669 Phone: 208-268-0089 Fax: 208-488-4248 | |
Boise River Physical Therapy Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 64 S Star Road, Suite 2, Star, ID 83669 Phone: 815-540-6065 Fax: 815-380-6355 |