Stephanie Liddle, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT-954 Issued in ID

Practice address

3125 Valencia Dr
Idaho Falls, ID 83404-7575

Phone

(208) 529-3332

Fax

(208) 529-3336

NPI assigned

Oct 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Performance Therapy, LLCGroup PAC ID 8426189648, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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 Therapy, LLC

  • Physical Therapist
  • Idaho Falls, ID
  • NPI 1427375724
  Medicare reassignment Care Compare group NPD Authorized official
• Peak Performance Therapy Services P C

  • Physical Therapist
  • Ammon, ID
  • NPI 1003898974
  NPD (past)

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

{
    "created_epoch": "1193616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1942489794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 S BONITO WAY STE 190",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425618",
            "telephone_number": "208-287-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 VALENCIA DR",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047575",
            "telephone_number": "208-529-3332",
            "fax_number": "208-529-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDLE",
        "first_name": "STEPHANIE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-29",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-077",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cathy Lewis, FNP-C
• Joshua Lewis
• McKylie Raellen Lewis, MS, RDN, LD
• Robert Taylor Lewis, CRNA
• Liberty Dialysis - Idaho Falls LLC
• Life Improvement Center, LLC
• Life Quest Family Solutions
• Life Spring Women's Clinic, P.a.
• Life Spring Womens Clinic, P.a.
• Lighthouse Counseling, LLC

• Physical Therapist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Physical Therapist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; 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.