NPIMap

Organization Active NPI

Pedersen Outpatient Physical Therapy

  • Physical Therapy Clinic/Center
  • Enumclaw, WA
National Provider Identifier
1104040856
Registry record updated Mar 7, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PEDERSEN OUTPATIENT PHYSICAL THERAPY
Practice address
1110 Stevenson Ave
Suite 100
Enumclaw, WA 98022-2647
Phone
(360) 825-7411
Fax
(360) 825-7434
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2008

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

Authorized official

Name
George Pedersen, M.P.T.NPI 1982771580
Title
Therapist
Phone
(360) 825-7411

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 1

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

Addresses

Primary practice location

1110 Stevenson Ave
Suite 100
Enumclaw, WA 98022-2647

Mailing address

1110 Stevenson Ave
Suite 100
Enumclaw, WA 98022-2647
Phone (360) 825-7411

National Provider Directory

National Provider Directory

Locations

1110 Stevenson Ave
Ste 100
Enumclaw, WA 98022
Phone (360) 825-7411

Practitioners & affiliated clinicians

Practitioners 2

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": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204848000000",
    "number": "1104040856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 STEVENSON AVE",
            "address_2": "SUITE 100",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222647",
            "telephone_number": "360-825-7411",
            "fax_number": "360-825-7434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 STEVENSON AVE",
            "address_2": "SUITE 100",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222647",
            "telephone_number": "360-825-7411",
            "fax_number": "360-825-7434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDERSEN OUTPATIENT PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2008-03-07",
        "status": "A",
        "authorized_official_last_name": "PEDERSEN",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "360-825-7411",
        "authorized_official_credential": "M.P.T."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enumclaw, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2008; 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.