Individual provider Active NPI

Viviane Huderle, PT,DPT

  • Physical Therapist
  • Fargo, ND
National Provider Identifier
1508534793
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
12389 Issued in MN
Practice address
1461 Broadway N
Fargo, ND 58102-2622
Phone
(701) 293-6037
NPI assigned
Sep 1, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 12389 MN Primary

Addresses

Primary practice location

1461 Broadway N
Fargo, ND 58102-2622

Mailing address

1461 Broadway N
Fargo, ND 58102-2622
Phone (701) 293-6037

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211103000123 MN Practitioner - Physical Therapist in Private Practice 7012305766

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Total Balance Dietitian, LLC CurrentSince Mar 24, 2024 Accepting new patients

Locations

1461 Broadway N
Fargo, ND 58102
Phone (701) 293-6037

1461 Broadway N
Ste 105
Fargo, ND 58102
Phone (701) 293-6037

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1630454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630454400000",
    "number": "1508534793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1461 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022622",
            "telephone_number": "701-293-6037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581022622",
            "telephone_number": "701-293-6037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDERLE",
        "first_name": "VIVIANE",
        "credential": "PT,DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "12389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.