Active NPI
Michael G Van Pevenage, RPT
- Physical Therapist
- Davenport, WA
National Provider Identifier
1184789703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00006484
- Practice address
- 506 Morgan Street
Davenport, WA 99122 - Phone
- (509) 725-7325
- Fax
- (509) 725-5325
- NPI assigned
- Dec 26, 2006
- Sex
- Male
- 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 | PT00006484 | WA | Primary |
Addresses
Primary practice location
506 Morgan Street
Davenport, WA 99122
Mailing address
PO Box 752
Davenport, WA 99122-0752
Phone (509) 725-7325
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7125768 | Medicaid | WA | |
| DF0622 | Other | WA | PALMETTO |
| 0205378 | Other | WA | LABOR AND INDUSTRIES |
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 |
|---|---|---|---|
| PT00006484 | WA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lincoln County Hospital District #3 | Past | Accepting new patients | |
| Peak Fitness Physical Therapy, PS | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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
- Davenport, WA
- NPI 1447384235
-
- Rural Health Clinic/Center
- Wilbur, WA
- NPI 1972547610
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350604800000",
"number": "1184789703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 752",
"city": "DAVENPORT",
"state": "WA",
"postal_code": "991220752",
"telephone_number": "509-725-7325",
"fax_number": "509-725-5325"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "506 MORGAN STREET",
"city": "DAVENPORT",
"state": "WA",
"postal_code": "99122",
"telephone_number": "509-725-7325",
"fax_number": "509-725-5325"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN PEVENAGE",
"first_name": "MICHAEL",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-26",
"last_updated": "2012-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00006484",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7125768",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO",
"identifier": "DF0622",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR AND INDUSTRIES",
"identifier": "0205378",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.