Active NPI
Tara Marie Lodi
- Physical Therapist
- Kellogg, ID
National Provider Identifier
1164901294
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT-2709
- Practice address
- 601 W Cameron Ave
Kellogg, ID 83837-2004 - Phone
- (208) 784-1625
- NPI assigned
- Aug 9, 2018
- Sex
- Female
- 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 | PT-2709 | ID | Primary |
Addresses
Primary practice location
601 W Cameron Ave
Kellogg, ID 83837-2004
Mailing address
203 Silver Saddle CT
Pinehurst, ID 83850-0002
Phone (208) 240-3328
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-2709 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1164901294",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "203 SILVER SADDLE CT",
"city": "PINEHURST",
"state": "ID",
"postal_code": "838500002",
"telephone_number": "208-240-3328",
"fax_number": "208-784-1692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 W CAMERON AVE",
"city": "KELLOGG",
"state": "ID",
"postal_code": "838372004",
"telephone_number": "208-784-1625"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LODI",
"first_name": "TARA",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-08-09",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT-2709",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kellogg, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.