NPIMap

Organization Active NPI

Twin Rivers Physical Therapy, LLC

  • Physical Therapist
  • Clarkston, WA
National Provider Identifier
1003982745
Registry record updated Dec 17, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00005041 Issued in WA
Legal business name
TWIN RIVERS PHYSICAL THERAPY, LLC
Practice address
725 6TH St
Ste 101
Clarkston, WA 99403-2006
Phone
(509) 758-8510
Fax
(509) 751-9149
NPI assigned
Nov 27, 2006
Last updated
Dec 17, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2009

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

Authorized official

Name
Mr. Brent W Wahlberg Jr., RPTNPI 1225133663
Title
PT Owner
Phone
(509) 758-8510

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT00005041 WA Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT396 ID

Addresses

Primary practice location

725 6TH St
Ste 101
Clarkston, WA 99403-2006

Mailing address

725 6TH St
Ste 101
Clarkston, WA 99403-2006
Phone (509) 758-8510

Other identifiers 3

IdentifierTypeStateIssuer
7018757MedicaidWA
000010007644OtherBLUE SHIELD
131422OtherWALI

National Provider Directory

National Provider Directory

Locations

725 6th St
Ste 101
Clarkston, WA 99403
Phone (509) 758-8510

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261008000000",
    "number": "1003982745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 6TH ST",
            "address_2": "STE 101",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032006",
            "telephone_number": "509-758-8510",
            "fax_number": "509-751-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 6TH ST",
            "address_2": "STE 101",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032006",
            "telephone_number": "509-758-8510",
            "fax_number": "509-751-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TWIN RIVERS PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2009-12-17",
        "status": "A",
        "authorized_official_last_name": "WAHLBERG",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PT OWNER",
        "authorized_official_telephone_number": "509-758-8510",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005041",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT396",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7018757",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "000010007644",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LI",
            "identifier": "131422",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarkston, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2009; 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.