NPIMap

Organization Active NPI

Premier Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Longview, WA
National Provider Identifier
1194934091
Registry record updated Aug 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
PREMIER PHYSICAL THERAPY, INC
Practice address
1118 14TH Ave
Longview, WA 98632-3017
Phone
(360) 636-4360
Fax
(360) 425-5250
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2010

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

Authorized official

Name
Mr. Mark S Purcell, PT
Title
Owner
Phone
(360) 636-4360

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1118 14TH Ave
Longview, WA 98632-3017

Mailing address

118 14TH Ave
Longview, WA 98632-3017
Phone (360) 636-4360

Other identifiers 2

IdentifierTypeStateIssuer
0162-456OtherWADEPARTMENT OF L&I
7072861MedicaidWA

National Provider Directory

National Provider Directory

Locations

1118 14th Ave
Longview, WA 98632
Phone (360) 636-4360

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1194934091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323017",
            "telephone_number": "360-636-4360",
            "fax_number": "360-425-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 14TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323017",
            "telephone_number": "360-636-4360",
            "fax_number": "360-425-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "PURCELL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-636-4360",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF L&I",
            "identifier": "0162-456",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7072861",
            "state": "WA"
        }
    ],
    "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 Aug 12, 2010; 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.