Phase 1 Physical Therapy PS

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

PHASE 1 PHYSICAL THERAPY PS

Practice address

5928 Highway 291
Nine Mile Falls, WA 99026-9525

Phone

(509) 465-5663

Fax

(509) 467-8663

NPI assigned

May 11, 2006

Organization subpart

No

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

Authorized official

Name

Joel T San Nicolas, PTNPI 1003866658

Title

Administrator

Phone

(509) 465-5663

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 6

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.

• Joel T San Nicolas, PT

  • Physical Therapist
  • Nine Mile Falls, WA
  • NPI 1003866658
  Medicare reassignment Care Compare group NPD Authorized official
• Blake H Lavin, DPT

  • Physical Therapist
  • Nine Mile Falls, WA
  • NPI 1427879451
  Medicare reassignment Care Compare group NPD
• Matthew P Fain, PT

  • Physical Therapist
  • Spokane, WA
  • NPI 1982700563
  Medicare reassignment Care Compare group
• Gene M Geddes, MPT

  • Physical Therapist
  • Spokane, WA
  • NPI 1447226618
  NPD (past)
• Angelica R Hulett, BSK, DPT

  • Physical Therapist
  • Nine Mile Falls, WA
  • NPI 1629804885
  NPD (past)
• Stephanie M Martin, LMT

  • Massage Therapist
  • Nine Mile Falls, WA
  • NPI 1952661860
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235189135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "NINE MILE FALLS",
            "state": "WA",
            "postal_code": "990260549",
            "telephone_number": "509-465-5663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5928 HIGHWAY 291",
            "city": "NINE MILE FALLS",
            "state": "WA",
            "postal_code": "990269525",
            "telephone_number": "509-465-5663",
            "fax_number": "509-467-8663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHASE 1 PHYSICAL THERAPY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SAN NICOLAS",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "509-465-5663",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7116437",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dustin Norman
• Northwest Family Nutrition
• Evonn LB O'Neill, M.D.
• Linda Diane Odell
• Lynn Adele Pankonin
• Robby C Riddle, MD
• Israel Rodriguez
• Joel T San Nicolas, PT
• Lindsay D Sanders
• Wednesday Shields, LICSW

• Physical Therapist in Nine Mile Falls, WA
• Providers in Nine Mile Falls, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.