NPIMap

Organization Active NPI

Kinetic Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Seattle, WA
National Provider Identifier
1023301868
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
602928536 Issued in WA
Legal business name
KINETIC PHYSICAL THERAPY LLC
Practice address
4828 California Ave SW
Seattle, WA 98116-4415
Phone
(206) 632-0163
Fax
(206) 932-2353
NPI assigned
May 26, 2011
Last updated
Aug 30, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Authorized official

Name
Fawn Jennie Coussens, MSPTNPI 1144277948
Title
Physical Therapist, Owner
Phone
(206) 632-0163

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapy Clinic/Center 261QP2000X 602928536 WA Primary

Addresses

Primary practice location

4828 California Ave SW
Seattle, WA 98116-4415

Mailing address

4828 California Ave SW
Seattle, WA 98116-4415
Phone (206) 632-0163

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220907000929 WA Part B Supplier - Clinic/Group Practice 0446634679 Receives reassigned benefits from 2 practitioners
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

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": "1306368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661817600000",
    "number": "1023301868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4828 CALIFORNIA AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164415",
            "telephone_number": "206-632-0163",
            "fax_number": "206-932-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4828 CALIFORNIA AVE SW",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164415",
            "telephone_number": "206-632-0163",
            "fax_number": "206-932-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINETIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-26",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A",
        "authorized_official_last_name": "COUSSENS",
        "authorized_official_first_name": "FAWN",
        "authorized_official_middle_name": "JENNIE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "206-632-0163",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "602928536",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.