NPIMap

Organization Active NPI

Pro Sport Physical Therapy, LLC

  • Physical Therapist
  • Gig Harbor, WA
National Provider Identifier
1114552155
Registry record updated Nov 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PRO SPORT PHYSICAL THERAPY, LLC
Practice address
5160 Borgen Blvd Ste 101
Gig Harbor, WA 98332-8809
Phone
(253) 853-4000
Fax
(253) 853-4001
NPI assigned
Mar 10, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2024

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

Authorized official

Name
Sean Spaulding, DC
Title
Owner
Phone
(253) 853-4000

Specialties & licenses 1

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

Addresses

Primary practice location

5160 Borgen Blvd Ste 101
Gig Harbor, WA 98332-8809

Mailing address

5160 Borgen Blvd Ste 101
Gig Harbor, WA 98332-8809
Phone (253) 853-4000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200728001114 WA Part B Supplier - Clinic/Group Practice 9436573177 Receives reassigned benefits from 13 practitioners
Practice locations: Gig Harbor, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1583798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731456000000",
    "number": "1114552155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5160 BORGEN BLVD STE 101",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328809",
            "telephone_number": "253-853-4000",
            "fax_number": "253-853-4001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5160 BORGEN BLVD STE 101",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "983328809",
            "telephone_number": "253-853-4000",
            "fax_number": "253-853-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO SPORT PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-10",
        "last_updated": "2024-11-13",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "SPAULDING",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "253-853-4000",
        "authorized_official_credential": "DC"
    },
    "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 Gig Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.