Individual provider Active NPI

Laura Nakata Vannucci, MPT

  • Physical Therapist
  • Pullman, WA
National Provider Identifier
1104844265
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00005587 Issued in WA
Practice address
840 SE Bishop Blvd
Suite 200
Pullman, WA 99163-5502
Phone
(509) 338-9204
Fax
(509) 338-9206
NPI assigned
Jul 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00005587 WA Primary

Addresses

Primary practice location

840 SE Bishop Blvd
Suite 200
Pullman, WA 99163-5502

Mailing address

840 SE Bishop Blvd
Suite 200
Pullman, WA 99163-5502
Phone (509) 338-9204

Other identifiers 3

IdentifierTypeStateIssuer
8421851MedicaidWA
0195910OtherWADEPT LABOR & INDUSTRY
3523VAOtherASURIS NORTHWEST

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050805000436 WA Practitioner - Physical Therapist in Private Practice 4284663824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proformance Physical Therapy, LLCGroup PAC ID 0840229480, 5 clinicians

Practice addresses (Care Compare)

1225 S Grand Ave
Suite B
Pullman, WA 99163-5289
Phone (509) 338-9204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00005587WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proformance Physical Therapy, LLC Physical Therapist CurrentSince Mar 16, 2005 Accepting new patients

Locations

1225 S Grand Ave
Ste B
Pullman, WA 99163
Phone (509) 338-9204

840 SE Bishop Blvd
Ste 200
Pullman, WA 99163
Phone (509) 338-9204

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1104844265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 SE BISHOP BLVD",
            "address_2": "SUITE 200",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635502",
            "telephone_number": "509-338-9204",
            "fax_number": "509-338-9206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 SE BISHOP BLVD",
            "address_2": "SUITE 200",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635502",
            "telephone_number": "509-338-9204",
            "fax_number": "509-338-9206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANNUCCI",
        "first_name": "LAURA",
        "middle_name": "NAKATA",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8421851",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT LABOR & INDUSTRY",
            "identifier": "0195910",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASURIS NORTHWEST",
            "identifier": "3523VA",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pullman, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.