Therasport Northwest, Inc

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00002905 Issued in WA

Legal business name

THERASPORT NORTHWEST, INC

Practice address

124 E Rowan Ave
Suite 202
Spokane, WA 99207-1214

Phone

(509) 484-0095

Fax

(509) 484-0477

NPI assigned

Apr 29, 2008

Last updated

Apr 29, 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. Dean David Evans Jr., PTNPI 1104041458

Title

Owner/President

Phone

(509) 484-0095

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 2

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.

• Dean David Evans Jr., PT

  • Physical Therapist
  • Spokane, WA
  • NPI 1104041458
  NPD (past) Authorized official
• Baylen L Kreiter, PT

  • Physical Therapist
  • Spokane Valley, WA
  • NPI 1902902570
  NPD (past)

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1245405224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 E ROWAN AVE",
            "address_2": "SUITE 202",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992071214",
            "telephone_number": "509-484-0095",
            "fax_number": "509-484-0477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 E ROWAN AVE",
            "address_2": "SUITE 202",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992071214",
            "telephone_number": "509-484-0095",
            "fax_number": "509-484-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THERASPORT NORTHWEST, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-29",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "509-484-0095",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00002905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100431",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "17438",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER NPI",
            "identifier": "1104041458",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Therapy Changes Everything PLLC
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• Therapy in Play
• Therapy Nook PLLC
• Theraspark
• Joshua Therrien
• Cynthia Thiel, DDS
• Savanna Lynne Thiel, CBT
• Jay Thielen Jr., SUDP
• Kassandra Thierauf

• Physical Therapist in Spokane, WA
• Providers in Spokane, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 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.