Dominique Tardif, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MASG-775 Issued in ID

Practice address

413 W Idaho St Ste 202
Boise, ID 83702-6065

Phone

(208) 781-0452

NPI assigned

Nov 30, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Peregrine Physical Therapy LLC

  • Physical Therapist
  • Boise, ID
  • NPI 1942128137
  NPD (past)
• Physical Therapy 180 LLC

  • Physical Therapist
  • Boise, ID
  • NPI 1669696910
  NPD (past)

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1821462987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 W IDAHO ST STE 202",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026065",
            "telephone_number": "208-781-0452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 W IDAHO ST STE 202",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837026065",
            "telephone_number": "208-781-0452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TARDIF",
        "first_name": "DOMINIQUE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-11-30",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "ID",
            "license": "MASG-775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "MASG775",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephanie Tappe, LPN
• Tara Ryan LCSW PLLC
• Madisen Taran
• Sarah Anne Tarantino, PHARMD
• Kerry Michelle Tarbet, RN
• Nicole Alexandra Tarricone, LPC
• Michelle Tassinari, LPC
• Ariana Anne Tate, RPH
• Kimberly Tate
• Nancy Lynn Tate, PA-C

• Massage Therapist in Boise, ID
• Providers in Boise, ID by specialty
• Massage Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; 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.