Individual provider Active NPI

Marlene Cameron, PT

  • Physical Therapist
  • Pocatello, ID
National Provider Identifier
1548569148
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-622 Issued in ID
Practice address
1033 W Quinn Rd
Pocatello, ID 83202-2425
Phone
(208) 233-4800
Fax
(208) 233-4887
NPI assigned
Mar 22, 2011
Last updated
Jun 21, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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 PT-622 ID Primary

Addresses

Primary practice location

1033 W Quinn Rd
Pocatello, ID 83202-2425

Mailing address

1033 W Quinn Rd
Pocatello, ID 83202-2425
Phone (208) 233-4800

Other identifiers 1

IdentifierTypeStateIssuer
PT-622OtherIDPT LICENCE

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)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1300752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1548569148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1033 W QUINN RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022425",
            "telephone_number": "208-233-4800",
            "fax_number": "208-233-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1033 W QUINN RD",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832022425",
            "telephone_number": "208-233-4800",
            "fax_number": "208-233-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMERON",
        "first_name": "MARLENE",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-22",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENCE",
            "identifier": "PT-622",
            "state": "ID"
        }
    ],
    "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 Jun 21, 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.

Verify at the official NPI Registry.