NPIMap

Organization Active NPI

Outpatient Physical Therapy & Sports Rehabilitation,Inc, PC

  • Physical Therapist
  • Kent, WA
National Provider Identifier
1144543323
Registry record updated Oct 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION,INC, PC
Practice address
8009 S 180TH Ste
112
Kent, WA 98032-1042
Phone
(425) 226-7827
Fax
(425) 251-5757
NPI assigned
Mar 2, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2013

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

Authorized official

Name
Ms. Diane Renee Baker
Title
Financial and Facility Management
Phone
(425) 413-4427

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

8009 S 180TH Ste
112
Kent, WA 98032-1042

Mailing address

26837 Maple Valley Highway
Suite 200
Maple Valley, WA 98038-9917
Phone (425) 413-4427

Other identifiers 2

IdentifierTypeStateIssuer
GAB11700OtherWAMEDICARE PTAN
7086606MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930036184 WA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 3678487063 Practice locations: Kent, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382486400000",
    "number": "1144543323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26837 MAPLE VALLEY HIGHWAY",
            "address_2": "SUITE 200",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980389917",
            "telephone_number": "425-413-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8009 S 180TH STE",
            "address_2": "112",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321042",
            "telephone_number": "425-226-7827",
            "fax_number": "425-251-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTPATIENT PHYSICAL THERAPY & SPORTS REHABILITATION,INC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "DIANE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "FINANCIAL AND FACILITY MANAGEMENT",
        "authorized_official_telephone_number": "425-413-4427",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GAB11700",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7086606",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; 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.