Individual provider Active NPI

Mary J Hindman, P.T.

  • Specialist
  • Deer Park, WA
National Provider Identifier
1194728717
Registry record updated Jul 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
PT00002167 Issued in WA
Practice address
707 S Park St
Deer Park, WA 99006-0948
Phone
(509) 276-8811
Fax
(866) 629-4801
NPI assigned
May 27, 2005
Last updated
Jul 6, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X PT00002167 WA Primary

Addresses

Primary practice location

707 S Park St
Deer Park, WA 99006-0948

Mailing address

707 S Park St
Deer Park, WA 99006-0948
Phone (509) 276-8811

Other identifiers 1

IdentifierTypeStateIssuer
8334187MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111018000293 WA Practitioner - Physical Therapist in Private Practice 1254503261 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deer Park Physical Therapy IncGroup PAC ID 6103716840, 6 clinicians

Practice addresses (Care Compare)

707 S Park St
Deer Park, WA 99006-7025
Phone (509) 276-8811

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00002167WAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Deer Park Physical Therapy Inc CurrentSince Jan 19, 1983 Accepting new patients
Revive Therapeutic Massage PastSince Nov 13, 2022 Accepting new patients

Locations

707 S Park St
Deer Park, WA 99006
Phone (509) 276-8811

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1341532800000",
    "number": "1194728717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S PARK ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990060948",
            "telephone_number": "509-276-8811",
            "fax_number": "866-629-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 S PARK ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990060948",
            "telephone_number": "509-276-8811",
            "fax_number": "866-629-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINDMAN",
        "first_name": "MARY",
        "middle_name": "J",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-05-27",
        "last_updated": "2012-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "PT00002167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8334187",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.