| Idaho Spine & Sports Physical Therapy | |
|
12072 Mcmillan Rd, Boise, ID 83713-2462 | |
| (208) 939-0533 | |
| (208) 939-3341 |
| Full Name | Idaho Spine & Sports Physical Therapy |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 12072 Mcmillan Rd, Boise, Idaho |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639365323 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225100000X | Physical Therapist | 1208 (Idaho) | Primary |
| 225X00000X | Occupational Therapist | 928 (Idaho) | Secondary |
| 235Z00000X | Speech-language Pathologist | 1455 (Idaho) | Secondary |
| Provider Name | Troy Lynn Reid |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1891728762 PECOS PAC ID: 8123912706 Enrollment ID: I20070420000400 |
| Provider Name | Robert B Adams |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1881775633 PECOS PAC ID: 9234121815 Enrollment ID: I20101222000876 |
| Provider Name | Jeffrey R. Taylor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346501962 PECOS PAC ID: 3971767120 Enrollment ID: I20120619000623 |
| Provider Name | Kristen M Folger |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1780052720 PECOS PAC ID: 6608157342 Enrollment ID: I20170111002309 |
| Provider Name | Devyn Dodge |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1538458120 PECOS PAC ID: 1658558986 Enrollment ID: I20170424000986 |
| Provider Name | Steven Michael Oswald |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194266007 PECOS PAC ID: 7012294309 Enrollment ID: I20171113002629 |
| Provider Name | Christopher George Olshavsky |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477986727 PECOS PAC ID: 1951545417 Enrollment ID: I20171209000362 |
| Provider Name | Gunjan D Patel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861987356 PECOS PAC ID: 8628326154 Enrollment ID: I20180731002771 |
| Provider Name | Taylor A Cavazos |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1952967671 PECOS PAC ID: 1658604129 Enrollment ID: I20190615000222 |
| Provider Name | Kimberly M Ehlke |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811558174 PECOS PAC ID: 1355677022 Enrollment ID: I20190802000019 |
| Provider Name | Denice Y Romero-marquez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1811379910 PECOS PAC ID: 4082990635 Enrollment ID: I20190912002697 |
| Provider Name | Matthew Wisehart |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063861060 PECOS PAC ID: 2062794688 Enrollment ID: I20191230000404 |
| Provider Name | Jordan Noel Henretty |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1538785050 PECOS PAC ID: 9133542822 Enrollment ID: I20200714001985 |
| Provider Name | Lindsay Freeborn |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1124005095 PECOS PAC ID: 5496773426 Enrollment ID: I20210519001838 |
| Provider Name | Nicole Bischel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1770159972 PECOS PAC ID: 3678973914 Enrollment ID: I20210608003255 |
| Provider Name | Elise Morrow |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1518533132 PECOS PAC ID: 2567863715 Enrollment ID: I20210625001841 |
| Provider Name | Amanda Howar |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801467568 PECOS PAC ID: 7214330976 Enrollment ID: I20210720000185 |
| Provider Name | Brandon Matthew Todd |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568139640 PECOS PAC ID: 6204233653 Enrollment ID: I20210928000629 |
| Provider Name | Taylor Feuz |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1578235248 PECOS PAC ID: 2264820646 Enrollment ID: I20211104001584 |
| Provider Name | Alex C Godderidge |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942951736 PECOS PAC ID: 7911390893 Enrollment ID: I20220217001756 |
| Provider Name | Ole Christian Borgesen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1043413230 PECOS PAC ID: 0648322313 Enrollment ID: I20220603001665 |
| Provider Name | Collin Larson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1023738986 PECOS PAC ID: 0547637381 Enrollment ID: I20221107003124 |
| Provider Name | Mariah Kay Boyd |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942754981 PECOS PAC ID: 4082981808 Enrollment ID: I20230929002525 |
| Provider Name | Jason Gramajo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1215791280 PECOS PAC ID: 3173968880 Enrollment ID: I20240304001064 |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Spine & Sports Physical Therapy 12072 Mcmillan Rd, Boise, ID 83713-2462 Ph: (208) 939-0533 | Idaho Spine & Sports Physical Therapy 12072 Mcmillan Rd, Boise, ID 83713-2462 Ph: (208) 939-0533 |
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: 703 S Americana Blvd Ste 130, Boise, ID 83702 Phone: 208-706-7530 | |
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 |