Active NPI
Frank Todd Dimick, ATC, LAT, LPTA
- Physical Therapy Assistant
- Pocatello, ID
National Provider Identifier
1366470031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA-2676
- Practice address
- 560 Memorial Dr
Suite C
Pocatello, ID 83201-4070 - Phone
- (208) 232-4267
- Fax
- (208) 232-4268
- NPI assigned
- Jun 29, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AT094 | ID | |
| Physical Therapy Assistant | 225200000X | PTA-2676 | ID | Primary |
Addresses
Primary practice location
560 Memorial Dr
Suite C
Pocatello, ID 83201-4070
Mailing address
560 Memorial Dr
Suite C
Pocatello, ID 83201-4070
Phone (208) 232-4267
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA-2676 | ID | MD | Physical Therapy Assistant |
| AT094 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151539200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309996800000",
"number": "1366470031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "560 MEMORIAL DR",
"address_2": "SUITE C",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014070",
"telephone_number": "208-232-4267",
"fax_number": "208-232-4268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "560 MEMORIAL DR",
"address_2": "SUITE C",
"city": "POCATELLO",
"state": "ID",
"postal_code": "832014070",
"telephone_number": "208-232-4267",
"fax_number": "208-232-4268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIMICK",
"first_name": "FRANK",
"middle_name": "TODD",
"credential": "ATC, LAT, LPTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-29",
"last_updated": "2011-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT094",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "ID",
"license": "PTA-2676",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.