NPIMap

Organization Active NPI

Independent Physical Therapy Associates

Doing business as Performance Physical Therapy

  • Physical Therapist
  • Spokane, WA
National Provider Identifier
1063585982
Registry record updated Jan 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
INDEPENDENT PHYSICAL THERAPY ASSOCIATES
Doing business as
Performance Physical Therapy
Practice address
12525 East Mission
Suite 104
Spokane, WA 99216-1079
Phone
(509) 928-1500
Fax
(509) 928-8006
NPI assigned
Nov 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2015

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

Authorized official

Name
Mr. David W Rudnick, PT
Title
PT Owner
Phone
(509) 928-1500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

12525 East Mission
Suite 104
Spokane, WA 99216-1079

Mailing address

12525 East Mission
Suite 104
Spokane, WA 99216-1079
Phone (509) 928-1500

Other names 1

  • Performance Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040608001328 WA Part B Supplier - Clinic/Group Practice 4486637766 Receives reassigned benefits from 2 practitioners
Practice locations: Spokane Vly, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421366400000",
    "number": "1063585982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12525 EAST MISSION",
            "address_2": "SUITE 104",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992161079",
            "telephone_number": "509-928-1500",
            "fax_number": "509-928-8006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12525 EAST MISSION",
            "address_2": "SUITE 104",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992161079",
            "telephone_number": "509-928-1500",
            "fax_number": "509-928-8006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENT PHYSICAL THERAPY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2015-01-16",
        "status": "A",
        "authorized_official_last_name": "RUDNICK",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PT OWNER",
        "authorized_official_telephone_number": "509-928-1500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Performance Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; 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.