Idaho Lung and Heart

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

IDAHO LUNG AND HEART

Doing business as

Idaho Lung and Heart

Practice address

38 S 2ND E
Rexburg, ID 83440-2671

Phone

(801) 616-7253

NPI assigned

Jan 26, 2024

Last updated

Feb 4, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bradley S CorderoNPI 1932494002

Title

Owner

Phone

(208) 359-9570

Specialties & licenses 2

Addresses

Other names 1

• Idaho Lung and Heart Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Locations

Practitioners 2

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.

• Bradley S Cordero, DPT

  • Physical Therapist
  • Rexburg, ID
  • NPI 1932494002
  Medicare reassignment NPD Authorized official
• Kimberly Fjelstrom, DPT

  • Physical Therapist
  • Riverton, UT
  • NPI 1619539780
  NPD

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

{
    "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 (Rexburg Counseling and Eating Disorder Center)
• Idaho in-Home Health & Social Services LLC
• Idaho Urology 1 PLLC (Mountain West Urology)
• Karen O Ili
• Integrated Counseling and Wellness, Inc. (Integrated Counseling and Wellness)
• Intouch Recovery
• J. B. Egbert Chiropractic LLC

• Physical Therapist in Rexburg, ID
• Providers in Rexburg, ID by specialty
• 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.