Tara L. Lewis, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7739 Issued in MN

Practice address

11855 Ulysses St NE
Blaine, MN 55434-3947

Phone

(763) 767-3140

Fax

(763) 767-3146

NPI assigned

Jun 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tara L Mathern Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Multicenter Physical Therapy, LLC

  • Physical Therapy Clinic/Center
  • Spring Lake Park, MN
  • NPI 1346287158
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1407899701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7700 HIGHWAY 65 NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322832",
            "telephone_number": "763-784-3155",
            "fax_number": "763-784-2352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11855 ULYSSES ST NE",
            "city": "BLAINE",
            "state": "MN",
            "postal_code": "554343947",
            "telephone_number": "763-767-3140",
            "fax_number": "763-767-3146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEWIS",
        "first_name": "TARA",
        "middle_name": "L.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "7739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5586330",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "MATHERN",
            "middle_name": "L",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leo Human Services LLC
• Joseph James Leveille
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• Kristen Emily Lewicki, NP-C
• Andrea L Lewis, DPT
• Gregory R Liebsch, DDS
• Life Jornee Home Health Care LLC
• Life's Companion P.C.a., Inc.
• Anne Marie Lillyblad, FNP
• Lincolnton Dialysis LLC (Central Avenue Dialysis)

• Physical Therapist in Blaine, MN
• Providers in Blaine, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.

Verify at the official NPI Registry.