Active NPI
Jamie Lynn Larsen, DPT
- Physical Therapist
- Lewiston, ID
National Provider Identifier
1720394174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2265
- Practice address
- 1010 Bryden Ave
Suite a
Lewiston, ID 83501-2713 - Phone
- (208) 746-0455
- Fax
- (208) 746-0688
- NPI assigned
- Aug 24, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2265 | ID | Primary |
| Physical Therapist | 225100000X | 00010795 | WA |
Addresses
Primary practice location
1010 Bryden Ave
Suite a
Lewiston, ID 83501-2713
Mailing address
1019 3Rd St
Lewiston, ID 83501-2713
Phone (208) 746-0455
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2265 | ID | MD | Physical Therapist |
| 00010795 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287532800000",
"number": "1720394174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1019 3RD ST",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835012713",
"telephone_number": "208-746-0455",
"fax_number": "208-746-0688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 BRYDEN AVE",
"address_2": "SUITE A",
"city": "LEWISTON",
"state": "ID",
"postal_code": "835012713",
"telephone_number": "208-746-0455",
"fax_number": "208-746-0688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JAMIE",
"middle_name": "LYNN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-08-24",
"last_updated": "2010-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "2265",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "00010795",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lewiston, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.