MEDICARE: PIERCE PHYSICAL THERAPY AND SPORTS REHAB LLC

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	PT-3309	ID

General Provider Information

NPI Number	:	1578076519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIERCE PHYSICAL THERAPY AND SPORTS REHAB LLC

Provider Business Mailing Address
First Line	:	4771 N SUMMIT WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5017
Country	:	US
Telephone Number	:	208-629-0656
Fax Number	:

Provider Business Practice Location Address
First Line	:	4771 N SUMMIT WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5017
Country	:	US
Telephone Number	:	208-629-0656
Fax Number	:	208-617-3077

Authorized Official
Title or Position	:	OWNER, PHYSICAL THERAPIST
Name	:	DR. BRETT PIERCE
Credential	:	DPT
Telephone Number	:	208-371-2610

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	05/20/2025

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