Proactive Orthopedic and Sports Physical Therapy of Vancouver, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

602338111 Issued in WA

Legal business name

PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF VANCOUVER, LLC

Practice address

805 Broadway St
Vancouver, WA 98660-3213

Phone

(360) 823-0138

Fax

(360) 823-0141

NPI assigned

Mar 31, 2006

Last updated

Jul 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Larry Dean Kraut

Title

Managing Member

Phone

(503) 740-8847

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

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.

• Denise Fusso, BS

  • Physical Therapist
  • Vancouver, WA
  • NPI 1053359679
  NPD (past)
• Kelly Lynn Parmelee, LMP NCBTMB

  • Specialist
  • Vancouver, WA
  • NPI 1982864062
  NPD (past)
• Kellie T Wilson, MPT

  • Physical Therapist
  • Bend, OR
  • NPI 1306982384
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1235190950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 52194",
            "address_2": "DEPT CODE 963",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850722194",
            "telephone_number": "503-489-1781",
            "fax_number": "503-489-1650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 BROADWAY ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986603213",
            "telephone_number": "360-823-0138",
            "fax_number": "360-823-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE ORTHOPEDIC AND SPORTS PHYSICAL THERAPY OF VANCOUVER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "KRAUT",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "503-740-8847",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "602338111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7122260",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Lauren Pritchett
• Lisa M Pritchett, RC
• Priya Mistry DDS PC
• Proactive Care Chiropractic
• Proactive Orthopedic and Sports Physical Therapy of East Vancouver LLC
• Proactive Physical Therapy -Salmon Creek
• Probrace, Inc.
• Naomy Procopoi, PA-C
• Project Patch
• Alena Teanna Prosdocimi

• Physical Therapy Clinic/Center in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physical Therapy Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2008; 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.