Individual provider Active NPI

Brian Duke, PT

  • Physical Therapist
  • Walla Walla, WA
National Provider Identifier
1285107748
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
60788424 Issued in WA
Practice address
1025 S 2ND Ave
Walla Walla, WA 99362-4116
Phone
(509) 897-2100
NPI assigned
Jan 8, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 62425 OR
Physical Therapist 225100000X 60788424 WA Primary

Addresses

Primary practice location

1025 S 2ND Ave
Walla Walla, WA 99362-4116

Mailing address

16083 SW Upper Boones Ferry Rd Ste 300
Tigard, OR 97224-7736
Phone (503) 443-6156

Other practice location 1

1 Hayden Bridge Way
Springfield, OR 97477-1347
Phone (541) 868-9430

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200330001178 WA Practitioner - Physical Therapist in Private Practice 7315286796 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1111 S 2ND Ave
Walla Wall, WA 99362-4118
Phone (509) 897-3700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60788424WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services - Washington Physical Therapist CurrentSince Mar 15, 2020 Accepting new patients
Providence Health & Services - Washington CurrentSince Mar 15, 2020 Accepting new patients
Therapeutic Associates Inc Physical Therapist Past Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

1111 S 2nd Ave
Walla Walla, WA 99362
Phone (509) 522-0100

340 S Park St
Walla Walla, WA 99362
Phone (509) 525-8863

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

1025 S 2nd Ave
Walla Walla, WA 99362
Phone (509) 525-0480

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1285107748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16083 SW UPPER BOONES FERRY RD STE 300",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247736",
            "telephone_number": "503-443-6156",
            "fax_number": "503-639-9699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S 2ND AVE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993624116",
            "telephone_number": "509-897-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hayden Bridge Way",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OR",
            "postal_code": "974771347",
            "country_code": "US",
            "telephone_number": "541-868-9430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DUKE",
        "first_name": "BRIAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-08",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "62425",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "60788424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.