Tim J Kudlock, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

0542 Issued in SD

Practice address

215 E Jackson Blvd
Suite B
Spearfish, SD 57783-2176

Phone

(605) 722-6880

Fax

(605) 722-6889

NPI assigned

Jan 31, 2007

Sex

Male

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 2

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.

• Performance Physical Therapy Prof

  • Physical Therapy Clinic/Center
  • Spearfish, SD
  • NPI 1568509289
  NPD (past)

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1720125438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 E JACKSON BLVD",
            "address_2": "SUITE B",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832176",
            "telephone_number": "605-722-6880",
            "fax_number": "605-722-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E JACKSON BLVD",
            "address_2": "SUITE B",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832176",
            "telephone_number": "605-722-6880",
            "fax_number": "605-722-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUDLOCK",
        "first_name": "TIM",
        "middle_name": "J",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SD",
            "license": "0542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5831434",
            "state": "SD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD SD",
            "identifier": "0041172",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jami Kortan, PA-C
• Austin James Kott, PHARM.D.
• Alec Kray, PT, DPT
• Krew Enterprises, Inc Bda Comfort Keepers, 490
• Krew Enterprises, Inc Dba Comfort Keepers 490
• Kalli Kuebler, PT, DPT
• Amy La Qua
• Gregory Larson, PA-C
• John Larson, PH.D.
• Jared Thane Laymon, MD

• Physical Therapist in Spearfish, SD
• Providers in Spearfish, SD by specialty
• Physical Therapist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.