MEDICARE: PICK PT NAMPA PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1548196587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PICK PT NAMPA PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	2422 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2422 12TH AVE RD
Second Line	:
City	:	NAMPA
State	:	ID
Zip	:	83686-6300
Country	:	US
Telephone Number	:	208-466-0566
Fax Number	:	208-697-5213

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MACKENZIE JACOBSON
Credential	:
Telephone Number	:	509-690-0859

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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