NPIMap

Organization Active NPI

Northwest Physical Therapy Sports Rehabilitation Center, Inc., P.S.

  • Physical Therapist
  • Mount Vernon, WA
National Provider Identifier
1174523054
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
600377134 Issued in WA
Legal business name
NORTHWEST PHYSICAL THERAPY SPORTS REHABILITATION CENTER, INC., P.S.
Practice address
110 N Laventure Rd
Ste a
Mount Vernon, WA 98273-3901
Phone
(360) 428-2700
Fax
(360) 428-2701
NPI assigned
Jul 21, 2005
Last updated
Apr 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Ernest K. Nihi
Title
Office Administration
Phone
(360) 428-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 600377134 WA Primary

Addresses

Primary practice location

110 N Laventure Rd
Ste a
Mount Vernon, WA 98273-3901

Mailing address

110 N Laventure Rd
Ste a
Mount Vernon, WA 98273-3901
Phone (360) 428-2700

Other identifiers 2

IdentifierTypeStateIssuer
CF8029OtherWARAILROAD MEDICARE
7155104MedicaidWA

National Provider Directory

National Provider Directory

Locations

135 W Fairhaven Ave
Ste 101
Burlington, WA 98233
Phone (360) 671-2900

702 E Fairhaven Ave
Burlington, WA 98233
Phone (360) 755-9111

410 W State St
Sedro Woolley, WA 98284
Phone (360) 873-8191

Practitioners & affiliated clinicians

Practitioners 8

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": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1174523054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 N LAVENTURE RD",
            "address_2": "STE A",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733901",
            "telephone_number": "360-428-2700",
            "fax_number": "360-428-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 N LAVENTURE RD",
            "address_2": "STE A",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982733901",
            "telephone_number": "360-428-2700",
            "fax_number": "360-428-2701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST PHYSICAL THERAPY SPORTS REHABILITATION CENTER, INC., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "NIHI",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATION",
        "authorized_official_telephone_number": "360-428-2700"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "600377134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CF8029",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7155104",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.