NPIMap

Organization Active NPI

Knelsen Twin Rivers Physical Therapy

  • Physical Therapist
  • Clarkston, WA
National Provider Identifier
1013669852
Registry record updated Apr 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
KNELSEN TWIN RIVERS PHYSICAL THERAPY
Practice address
725 6TH St
Clarkston, WA 99403-2006
Phone
(508) 769-0004
NPI assigned
Jan 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2022

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

Authorized official

Name
Mariette Osburn
Title
Billing
Phone
(208) 791-7903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

725 6TH St
Clarkston, WA 99403-2006

Mailing address

725 6TH St
Clarkston, WA 99403-2006
Phone (508) 769-0004

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220620000416 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6002295243 Receives reassigned benefits from 5 practitioners
Practice locations: Clarkston, WA

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1642982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650931200000",
    "number": "1013669852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 6TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032006",
            "telephone_number": "508-769-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725 6TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032006",
            "telephone_number": "508-769-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNELSEN TWIN RIVERS PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-24",
        "last_updated": "2022-04-26",
        "certification_date": "2022-04-26",
        "status": "A",
        "authorized_official_last_name": "OSBURN",
        "authorized_official_first_name": "MARIETTE",
        "authorized_official_title_or_position": "BILLING",
        "authorized_official_telephone_number": "208-791-7903"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Apr 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.