Idaho Pediatric Therapy Clinic PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-1450 Issued in ID

Legal business name

IDAHO PEDIATRIC THERAPY CLINIC PLLC

Practice address

3080 E Gentry Way Ste 180
Meridian, ID 83642-3544

Phone

(208) 939-3334

Fax

(208) 939-1122

NPI assigned

Sep 3, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Longoria

Title

Office Manager

Phone

(208) 939-3334

Specialties & licenses 3

Addresses

Other identifiers 2

Locations

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Bret Adams, MPT

  • Physical Therapist
  • Boise, ID
  • NPI 1881775633
  NPD
• Laura K Brunello, MOTR/L

  • Pediatric Occupational Therapist
  • Meridian, ID
  • NPI 1124634266
  NPD
• Hannah Lynn Cummings, MS CF-SLP

  • Speech-Language Pathologist
  • Meridian, ID
  • NPI 1760210405
  NPD
• Lucas Keller

  • Pediatric Physical Therapist
  • Meridian, ID
  • NPI 1588230429
  NPD
• Joshua Mason, DPT

  • Specialist
  • Lynnwood, WA
  • NPI 1467786285
  NPD
• Carolyn Block, MSPT

  • Physical Therapist
  • Boise, ID
  • NPI 1477194736
  NPD (past)
• Brian M Holgate, MPT

  • Physical Therapist
  • Boise, ID
  • NPI 1629312269
  NPD (past)
• Carlie M Lausen, DPT

  • Physical Therapist
  • Boise, ID
  • NPI 1427288356
  NPD (past)
• Jenny Martin, MS, SLP-CFY

  • Speech-Language Pathologist
  • Boise, ID
  • NPI 1639648025
  NPD (past)
• Kristin Orlando, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Sandpoint, ID
  • NPI 1780095547
  NPD (past)
• Spencer Andrew Simpson, APRN-CNP

  • Nurse Practitioner
  • Meridian, ID
  • NPI 1740048644
  NPD (past)
• Patricia M Speck, OTR/L

  • Occupational Therapist
  • Meridian, ID
  • NPI 1689015174
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1409702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562630400000",
    "number": "1194125617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 180",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "089-393-3342",
            "fax_number": "208-939-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3080 E GENTRY WAY STE 180",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836423544",
            "telephone_number": "208-939-3334",
            "fax_number": "208-939-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO PEDIATRIC THERAPY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-03",
        "last_updated": "2019-07-09",
        "status": "A",
        "authorized_official_last_name": "LONGORIA",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "208-939-3334"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-1450",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "ID",
            "license": "OT-928",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "ID",
            "license": "SLP-2249",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194125617",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013086610",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Idaho Mental Wellness Counseling
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• Idaho Pediatric Speech and Language, LLC
• Idaho Physical Medicine and Rehabilitation PA
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• Idaho Sleep and Wellness LLC
• Idaho Spine & Pain PLLC
• Idaho Spine and Sports Physical Therapy - Silverstone

• Physical Therapist in Meridian, ID
• Providers in Meridian, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.