Idaho Lung and Heart

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

IDAHO LUNG AND HEART

Practice address

38 S 2ND E
Rexburg, ID 83440-2671

Phone

(801) 616-7253

NPI assigned

Jan 26, 2024

Organization subpart

No

Name

Bradley S CorderoNPI 1932494002

Title

Owner

Phone

(208) 359-9570

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

• Bradley S Cordero, DPT

  • Physical Therapist
  • Rexburg, ID
  • NPI 1932494002

  ID, Physical Therapist

  Medicare reassignment NPD Authorized official
• Kimberly Fjelstrom, DPT

  • Physical Therapist
  • Riverton, UT
  • NPI 1619539780
  NPD

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

• Idaho Lung and Heart Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 4, 2025.

{
    "created_epoch": "1706227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738627200000",
    "number": "1306608104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 S 2ND E STE 2",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402675",
            "telephone_number": "801-616-7253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 S 2ND E",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402671",
            "telephone_number": "801-616-7253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDAHO LUNG AND HEART",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-26",
        "last_updated": "2025-02-04",
        "certification_date": "2025-02-04",
        "status": "A",
        "authorized_official_last_name": "CORDERO",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-359-9570"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Idaho Lung and Heart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Idaho Lung and Heart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Idaho Dept of Health & Welfare Region 7 Amh PSR Rexburg
• Idaho Dept of Health & Welfare Region 7 CMH Clinic Rexburg
• Idaho Dept of Health & Welfare Region 7 CMH PSR Rexburg
• Idaho Ed Counseling, LLC
• Idaho in-Home Health & Social Services LLC
• Idaho Urology 1 PLLC
• Karen O Ili
• Integrated Counseling and Wellness, Inc.
• Intouch Recovery
• J & S Enterprises Inc

• All providers in Rexburg, ID
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.