NPIMap

Organization Active NPI

Bellevue Sports Medicine Clinic Inc

  • Physical Therapist
  • Bellevue, WA
National Provider Identifier
1124039870
Registry record updated Dec 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00010137 Issued in WA
Legal business name
BELLEVUE SPORTS MEDICINE CLINIC INC
Practice address
11400 SE 6TH St
Suite 130
Bellevue, WA 98004-6423
Phone
(425) 455-0699
Fax
(425) 455-1541
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2007

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

Authorized official

Name
Keely J Kowalchuk, PTNPI 1164521134
Title
Director
Phone
(425) 455-0699

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 TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00010137 WA Primary

Addresses

Primary practice location

11400 SE 6TH St
Suite 130
Bellevue, WA 98004-6423

Mailing address

11400 SE 6TH St
Suite 130
Bellevue, WA 98004-6423
Phone (425) 455-0699

Other identifiers 1

IdentifierTypeStateIssuer
0030120OtherWAWA DEPT LABOR AND INDUSTR

National Provider Directory

National Provider Directory

Locations

11400 SE 6th St
Ste 130
Bellevue, WA 98004
Phone (425) 455-0699

Practitioners & affiliated clinicians

Practitioners 7

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": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196812800000",
    "number": "1124039870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 SE 6TH ST",
            "address_2": "SUITE 130",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046423",
            "telephone_number": "425-455-0699",
            "fax_number": "425-455-1541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 SE 6TH ST",
            "address_2": "SUITE 130",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046423",
            "telephone_number": "425-455-0699",
            "fax_number": "425-455-1541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE SPORTS MEDICINE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-12-05",
        "status": "A",
        "authorized_official_last_name": "KOWALCHUK",
        "authorized_official_first_name": "KEELY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "425-455-0699",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010137",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA DEPT LABOR AND INDUSTR",
            "identifier": "0030120",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2007; 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.