NPIMap

Organization Active NPI

Longview Physical and Sports Therapy Services PS

  • Physical Therapist
  • Longview, WA
National Provider Identifier
1184835100
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
LONGVIEW PHYSICAL AND SPORTS THERAPY SERVICES PS
Practice address
625 9TH Avenue
Suite 220
Longview, WA 98632
Phone
(360) 578-1188
Fax
(360) 578-6251
NPI assigned
May 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Bruce E Peterson, PTNPI 1306844063
Title
Owner
Phone
(360) 578-1188

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X WA Primary

Addresses

Primary practice location

625 9TH Avenue
Suite 220
Longview, WA 98632

Mailing address

625 9TH Avenue
Suite 220
Longview, WA 98632
Phone (360) 578-1188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040422000257 WA Part B Supplier - Clinic/Group Practice 6305832668 Receives reassigned benefits from 12 practitioners
Practice locations: Longview, WA
O20200113000802 WA DME Supplier - Independently-Practicing Physical TherapistDME Supplier - Independently-Practicing Occupational Therapist 6305832668 Practice locations: Longview, WA

National Provider Directory

National Provider Directory

Locations

625 9th Ave
Ste 220
Longview, WA 98632
Phone (360) 578-1188

900 Fir St
Ste 1J
Longview, WA 98632
Phone (360) 578-1188

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1184835100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 9TH AVENUE",
            "address_2": "SUITE 220",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-578-1188",
            "fax_number": "360-578-6251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 9TH AVENUE",
            "address_2": "SUITE 220",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-578-1188",
            "fax_number": "360-578-6251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONGVIEW PHYSICAL AND SPORTS THERAPY SERVICES PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-578-1188",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.