Madhu Enjati, PT
Individual provider Active NPI Physical Therapist · Liberty Lake, WA
NPI 1114214079 · NPPES record last updated Jun 29, 2011
Key facts
- NPI
- 1114214079
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT60213179 (WA)
- Practice address
- 21200 E Country Vista Dr
D101
Liberty Lake, WA 99019-7636 - Phone
- (623) 521-8653
- NPI assigned
- Jun 29, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Paragon Outpatient Rehabilitation Services LLC
Practice addresses (Care Compare)
935 Page St
Mt Pleasant, NC 28124-9735
Phone (704) 550-3527
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260121000671 | NC | Practitioner - Physical Therapist in Private Practice | 9436166311 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT60213179 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paragon Outpatient Rehabilitation Services, LLC | Physical Therapist | Current |
Accepting new patients |
| Paragon Outpatient Rehabilitation Services, LLC | Current |
Accepting new patients | |
| Anderson & Bates Inc | Physical Therapist | Past |
Accepting new patients |
Locations
935 Page St
Mt Pleasant, NC 28124
Phone (704) 346-2923
612 China Grove Hwy
Rockwell, NC 28138
Phone (704) 279-5300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60213179 | WA | Yes |
Addresses
Primary practice location
21200 E Country Vista Dr
D101
Liberty Lake, WA 99019-7636
Mailing address
21200 E Country Vista Dr
D101
Liberty Lake, WA 99019-7636
Other providers in Liberty Lake, WA
- Dawn Dunagan
- Elizabeth A Duran
- Chase Anthony Earling
- Mathew Edwards
- Barry Ehlert
- Jared Dean Evans
- Evergreen Dermatopathology PLLC
- Evergreen Mental Health LLC
- Isabella Faccone
- Family Home Care Corporation
All providers in Liberty Lake, WA · Physical Therapist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.