NPIMap

Organization Active NPI

Kitsap Physical Therapy and Sports Clinic PS Inc

  • Durable Medical Equipment & Medical Supplies
  • Bainbridge Island, WA
National Provider Identifier
1154901437
Registry record updated May 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC
Practice address
945 Hildebrand LN NE Ste 220
Bainbridge Island, WA 98110-2877
Phone
(206) 842-6288
Fax
(360) 598-3282
NPI assigned
Apr 12, 2021
Last updated
May 21, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 21, 2021

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

Authorized official

Name
Summer Zumwalt
Title
HRD
Phone
(360) 598-3764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

945 Hildebrand LN NE Ste 220
Bainbridge Island, WA 98110-2877

Mailing address

2400 NW Myhre Rd Ste 101
Silverdale, WA 98383-7672
Phone (360) 598-3764

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210623003148 WA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 6507762333 Practice locations: Silverdale, WA

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Kitsap PT Sports Clin4 organizations share this tax ID, including this one
Part of
Kitsap PT Sports Clin

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1618185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621555200000",
    "number": "1154901437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 NW MYHRE RD STE 101",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983837672",
            "telephone_number": "360-598-3764",
            "fax_number": "360-598-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "945 HILDEBRAND LN NE STE 220",
            "city": "BAINBRIDGE ISLAND",
            "state": "WA",
            "postal_code": "981102877",
            "telephone_number": "206-842-6288",
            "fax_number": "360-598-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC",
        "enumeration_date": "2021-04-12",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A",
        "authorized_official_last_name": "ZUMWALT",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "HRD",
        "authorized_official_telephone_number": "360-598-3764"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bainbridge Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2021; 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.