Active NPI
Kimberly Soderholm, PT
- Physical Therapist
- West Fargo, ND
National Provider Identifier
1326219601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 800
- Practice address
- 109 3Rd St E
Ecse Lodeon Center
West Fargo, ND 58078-1817 - Phone
- (701) 356-2115
- NPI assigned
- Mar 14, 2008
- 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 | 800 | ND | Primary |
Addresses
Primary practice location
109 3Rd St E
Ecse Lodeon Center
West Fargo, ND 58078-1817
Mailing address
109 3Rd St E
Ecse Lodeon Center
West Fargo, ND 58078-1817
Phone (701) 356-2115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50095 | Medicaid | ND |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205452800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205452800000",
"number": "1326219601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 3RD ST E",
"address_2": "ECSE LODEON CENTER",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580781817",
"telephone_number": "701-356-2115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 3RD ST E",
"address_2": "ECSE LODEON CENTER",
"city": "WEST FARGO",
"state": "ND",
"postal_code": "580781817",
"telephone_number": "701-356-2115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SODERHOLM",
"first_name": "KIMBERLY",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-14",
"last_updated": "2008-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ND",
"license": "800",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "50095",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.