Individual provider Active NPI

Juliet M Tardy

  • Physical Therapist
  • Anchorage, AK
National Provider Identifier
1720194988
Registry record updated Jun 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
737 Issued in AK
Practice address
2740 Lake Otis Pkwy
Anchorage, AK 99508-4141
Phone
(907) 743-3310
NPI assigned
Aug 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2018

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 737 AK Primary

Addresses

Primary practice location

2740 Lake Otis Pkwy
Anchorage, AK 99508-4141

Mailing address

4800 Ridge Top Cir
Anchorage, AK 99508-3793

Other identifiers 1

IdentifierTypeStateIssuer
PT1090MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100804000087 AK Practitioner - Physical Therapist in Private Practice 1658404181 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5353 Lake Otis Pkwy
Anchorage, AK 99507-1709
Phone (907) 310-2290

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
737AKMDRehabilitation Chiropractor

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530144000000",
    "number": "1720194988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 RIDGE TOP CIR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995083793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2740 LAKE OTIS PKWY",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995084141",
            "telephone_number": "907-743-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARDY",
        "first_name": "JULIET",
        "middle_name": "M",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2018-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AK",
            "license": "737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT1090",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.