NPIMap

Organization Active NPI

Idaho Pediatric Therapy Clinic PLLC

  • Physical Therapist
  • Meridian, ID
National Provider Identifier
1194125617
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
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
Last updated
Jul 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT-1450 ID Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OT-928 ID
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SLP-2249 ID

Addresses

Primary practice location

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

Mailing address

3080 E Gentry Way Ste 180
Meridian, ID 83642-3544
Phone (089) 393-3342

National Provider Directory

National Provider Directory

Locations

3071 E Franklin Rd
Ste 303
Meridian, ID 83642
Phone (208) 939-3334

3080 E Gentry Way
Ste 180
Meridian, ID 83642
Phone (208) 609-6600

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • 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.