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

Nickalus Shane Davis, PT

Individual provider Physical Therapist · NPI 1336615749

Nickalus Shane Davis, PT is a Physical Therapist in Private Practice in Boise, Idaho. Qualified in 2018, 8 years ago. Practices with McMartin LLC, a 2-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
8
Licensed in
ID
In the registry since
2018
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

1010 S Allante Pl Ste 101
Boise, ID 83709-1660
Phone: (208) 370-5166
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT-5619 (ID)

Record details

NPI number1336615749
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedOctober 23, 2018
Last updated in NPPESApril 18, 2023
Certification dateApril 18, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice McMartin Llc — 2 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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