Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jared Clive Sansom, PTA

Individual provider Physical Therapy Assistant · NPI 1790359594

Jared Clive Sansom, PTA is a Physical Therapy Assistant in Boise, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2021
What do these letters mean?
PTA — Physical Therapist Assistant
Delivers treatment under a physical therapist's direction.

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Practice location Address checks out

3352 N Kingswood Way
Boise, ID 83704-4385
Phone: (208) 421-5991
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA-4725 (ID)

Record details

NPI number1790359594
Entity typeIndividual (Type 1)
GenderMale
Credentials PTA
Sole proprietorYes
NPI enumeratedMay 17, 2021
Last updated in NPPESMay 17, 2021
Certification dateMay 17, 2021
Mailing address3352 N Kingswood Way, Boise, ID 83704-4385

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