NPIMap

Organization Active NPI

Olympic Sports and Spine Rehabilitation, P.S.

  • Physical Therapist
  • Puyallup, WA
National Provider Identifier
1144685306
Registry record updated Dec 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
OLYMPIC SPORTS AND SPINE REHABILITATION, P.S.
Practice address
17520 Meridian E
Suite F
Puyallup, WA 98375-6265
Phone
(253) 864-7595
Fax
(253) 864-0457
NPI assigned
Dec 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2015

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

Authorized official

Name
Brian Thacker, PT
Title
Vice President
Phone
(253) 581-5200

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

17520 Meridian E
Suite F
Puyallup, WA 98375-6265

Mailing address

9315 Gravelly Lake Dr SW
Suite 306
Lakewood, WA 98499-1574
Phone (253) 581-5200

National Provider Directory

National Provider Directory

Locations

17520 Meridian E
Ste F
Puyallup, WA 98375
Phone (253) 864-7595

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1450137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1144685306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9315 GRAVELLY LAKE DR SW",
            "address_2": "SUITE 306",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991574",
            "telephone_number": "253-581-5200",
            "fax_number": "253-581-5203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17520 MERIDIAN E",
            "address_2": "SUITE F",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983756265",
            "telephone_number": "253-864-7595",
            "fax_number": "253-864-0457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLYMPIC SPORTS AND SPINE REHABILITATION, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-15",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "THACKER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "253-581-5200",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2015; 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.