Active NPI
Diane Marie Eidam, P.T.
- Physical Therapist
- Edina, MN
National Provider Identifier
1891716833
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 653
- Practice address
- 3400 W 66TH St
Suite 150
Edina, MN 55435-2109 - Phone
- (952) 920-8088
- Fax
- (763) 302-4219
- NPI assigned
- Jul 23, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 653 | MN | Primary |
Addresses
Primary practice location
3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Mailing address
3400 W 66TH St
Suite 150
Edina, MN 55435-2109
Phone (952) 920-8088
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10A51EI | Other | MN | BCBS OF MN |
| 6429736 | Other | MN | MEDICA |
| 962871010735 | Other | MN | PREFERRED ONE |
| 793845 | Other | MN | AMERICA'S PPO |
| HP44376 | Other | MN | HEALTHPARTNERS |
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 |
|---|---|---|---|
| 653 | MN | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153612800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323129600000",
"number": "1891716833",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 W 66TH ST",
"address_2": "SUITE 150",
"city": "EDINA",
"state": "MN",
"postal_code": "554352109",
"telephone_number": "952-920-8088",
"fax_number": "763-302-4219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 W 66TH ST",
"address_2": "SUITE 150",
"city": "EDINA",
"state": "MN",
"postal_code": "554352109",
"telephone_number": "952-920-8088",
"fax_number": "763-302-4219"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDAM",
"first_name": "DIANE",
"middle_name": "MARIE",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-23",
"last_updated": "2011-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "653",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MN",
"identifier": "10A51EI",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "6429736",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "962871010735",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICA'S PPO",
"identifier": "793845",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP44376",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edina, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.