Homegrown Pediatric Therapies LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

HOMEGROWN PEDIATRIC THERAPIES LLC

Practice address

8000 S 55TH W
Idaho Falls, ID 83402-5733

Phone

(208) 613-7361

Fax

(843) 892-8444

NPI assigned

Jun 9, 2025

Organization subpart

Yes

Parent organization

HOMEGROWN PEDIATRIC THERAPIES LLCAs reported in NPPES

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

Authorized official

Name

Ross Gardner, PT, DPTNPI 1669944831

Title

Owner, Physical Therapist

Phone

(208) 613-7361

Specialties & licenses 7

Addresses

Tax ID family

Homegrown Pediatric Therapies LLC2 organizations share this tax ID, including this one

Part of

Homegrown Pediatric Therapies LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Homegrown Pediatric Therapies LLC

  • Physical Therapist
  • Summerville, SC
  • NPI 1043910441
  NPD tax ID

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ross Gardner, DPT

  • Physical Therapist
  • Summerville, SC
  • NPI 1669944831
  NPD Authorized official
• Tessa Marjean Woodin

  • Physical Therapy Assistant
  • Idaho Falls, ID
  • NPI 1942149943
  NPD (past)
• Steven Shepherd

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1376122697
  NPD (past)

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

{
    "created_epoch": "1749427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750723200000",
    "number": "1992690101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8000 S 55TH W",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025733",
            "telephone_number": "208-613-7361",
            "fax_number": "843-892-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8000 S 55TH W",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834025733",
            "telephone_number": "208-613-7361",
            "fax_number": "843-892-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMEGROWN PEDIATRIC THERAPIES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOMEGROWN PEDIATRIC THERAPIES LLC",
        "enumeration_date": "2025-06-09",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-613-7361",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2355S0801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Speech-Language Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 Jun 24, 2025; 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.