Active NPI
Tanner Thomas Lafollette, DPT
- Physical Therapist
- Los Angeles, CA
National Provider Identifier
1154055440
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 302354
- Practice address
- 1640 Marengo St BLDG Suite102
Los Angeles, CA 90033-1036 - Phone
- (323) 865-1200
- NPI assigned
- Jul 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 302354 | CA | Primary |
Addresses
Primary practice location
1640 Marengo St BLDG Suite102
Los Angeles, CA 90033-1036
Mailing address
PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 865-1200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302354 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1657584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1154055440",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31309",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900310309",
"telephone_number": "323-865-1200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 MARENGO ST BLDG SUITE102",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900331036",
"telephone_number": "323-865-1200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAFOLLETTE",
"first_name": "TANNER",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-07-12",
"last_updated": "2022-08-29",
"certification_date": "2022-08-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "302354",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.