Provider Demographics
NPI:1851370613
Name:TODD, JAMI LEE (MPT CSCS)
Entity Type:Individual
Prefix:MS
First Name:JAMI
Middle Name:LEE
Last Name:TODD
Suffix:
Gender:F
Credentials:MPT CSCS
Other - Prefix:MS
Other - First Name:JAMI
Other - Middle Name:LEE
Other - Last Name:HARTWIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT CSCS
Mailing Address - Street 1:1590 E POLSTON AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5218
Mailing Address - Country:US
Mailing Address - Phone:208-777-4242
Mailing Address - Fax:208-777-4020
Practice Address - Street 1:3322 GRAND MILL LANE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-665-2000
Practice Address - Fax:208-665-2009
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03392225100000X
IDPT-2391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID808068700Medicaid
ID808068700Medicaid