Active NPI
Kathy A Dufur, PT ATC
- Physical Therapist
- Nampa, ID
National Provider Identifier
1265421291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT1564
- Practice address
- 4400 E Flamingo Ave
Nampa, ID 83687-9203 - Phone
- (208) 288-4970
- Fax
- (208) 463-3044
- NPI assigned
- Oct 21, 2005
- 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 | PT1564 | ID | Primary |
Addresses
Primary practice location
4400 E Flamingo Ave
Nampa, ID 83687-9203
Mailing address
217 W Georgia Ave
Ste 115
Nampa, ID 83686-6811
Phone (208) 463-3234
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00217064 | Other | ID | RAILROAD MEDICARE |
| TC308 | Other | ID | BLUE CROSS |
| 000010150173 | Other | ID | BLUE SHIELD |
| 807199600 | Medicaid | ID |
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 |
|---|---|---|---|
| PT1564 | ID | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1265673600000",
"number": "1265421291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 W GEORGIA AVE",
"address_2": "STE 115",
"city": "NAMPA",
"state": "ID",
"postal_code": "836866811",
"telephone_number": "208-463-3234",
"fax_number": "208-463-3044"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 E FLAMINGO AVE",
"city": "NAMPA",
"state": "ID",
"postal_code": "836879203",
"telephone_number": "208-288-4970",
"fax_number": "208-463-3044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUFUR",
"first_name": "KATHY",
"middle_name": "A",
"credential": "PT ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-21",
"last_updated": "2010-02-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT1564",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00217064",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "TC308",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "000010150173",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "807199600",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nampa, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.