NPIMap

Organization Active NPI

PNW Physical Therapy, LLC

  • Physical Therapist
  • Everett, WA
National Provider Identifier
1073086641
Registry record updated Feb 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PNW PHYSICAL THERAPY, LLC
Practice address
10821 19TH Ave SE
Everett, WA 98208-5103
Phone
(509) 458-7686
Fax
(509) 808-2164
NPI assigned
Jan 7, 2019
Last updated
Feb 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2024

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

Authorized official

Name
Cyndee H Reeves
Title
Credentialing Manager
Phone
(509) 458-7686

Specialties & licenses 1

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

Addresses

Primary practice location

10821 19TH Ave SE
Everett, WA 98208-5103

Mailing address

10821 19TH Ave SE Ste 102
Everett, WA 98208-5103
Phone (425) 225-5865

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190626001719 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5890029755 Receives reassigned benefits from 5 practitioners
Practice locations: Everett, WA

National Provider Directory

National Provider Directory

Locations

10821 19th Ave SE
Ste 102
Everett, WA 98208
Phone (425) 225-5865

Practitioners & affiliated clinicians

Practitioners 6

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": "1546819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708041600000",
    "number": "1073086641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10821 19TH AVE SE STE 102",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982085103",
            "telephone_number": "425-225-5865",
            "fax_number": "425-948-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10821 19TH AVE SE",
            "city": "EVERETT",
            "state": "WA",
            "postal_code": "982085103",
            "telephone_number": "509-458-7686",
            "fax_number": "509-808-2164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNW PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-07",
        "last_updated": "2024-02-16",
        "certification_date": "2024-02-16",
        "status": "A",
        "authorized_official_last_name": "REEVES",
        "authorized_official_first_name": "CYNDEE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "509-458-7686"
    },
    "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 Everett, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2024; 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.