Active NPI
Marlita Chantry, PT
- Physical Therapist
- Colville, WA
National Provider Identifier
1124092184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00007570
- Practice address
- 217 E 2ND Ave
Colville, WA 99114-2903 - Phone
- (509) 684-5027
- Fax
- (509) 684-6133
- NPI assigned
- Feb 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00007570 | WA | Primary |
Addresses
Primary practice location
217 E 2ND Ave
Colville, WA 99114-2903
Mailing address
397072 Highway 20
Cusick, WA 99119
Phone (509) 993-5360
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8335168 | Medicaid | WA | |
| 0208712 | Other | L & I | |
| 159194 | Other | WA | L & I |
Other names 1
- Marlita Fristad
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00007570 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gordon Physical Therapy, PLLC | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Spokane Valley, WA
- NPI 1265585335
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139961600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124092184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "397072 HIGHWAY 20",
"city": "CUSICK",
"state": "WA",
"postal_code": "99119",
"telephone_number": "509-993-5360"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 E 2ND AVE",
"city": "COLVILLE",
"state": "WA",
"postal_code": "991142903",
"telephone_number": "509-684-5027",
"fax_number": "509-684-6133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHANTRY",
"first_name": "MARLITA",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00007570",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8335168",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "0208712",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I",
"identifier": "159194",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "MARLITA",
"last_name": "FRISTAD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colville, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.