NPIMap

Organization Active NPI

Bellevue Sports & Spine Physical Therapy PS

  • Physical Therapist
  • Bellevue, WA
National Provider Identifier
1285718015
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BELLEVUE SPORTS & SPINE PHYSICAL THERAPY PS
Practice address
1975 112TH Ave NE Ste 100
Bellevue, WA 98004-2942
Phone
(425) 450-9801
Fax
(425) 450-9778
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Authorized official

Name
Mrs. Russell Kowalinski, PT
Title
Owner
Phone
(425) 450-9801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X WA Primary

Addresses

Primary practice location

1975 112TH Ave NE Ste 100
Bellevue, WA 98004-2942

Mailing address

1605 116TH Ave NE
Suite 110
Bellevue, WA 98004-3034
Phone (425) 450-9801

Other names 1

  • Peak Sports & Spine Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040325000231 WA Part B Supplier - Clinic/Group Practice 8123910379 Receives reassigned benefits from 8 practitioners
Practice locations: Bellevue, WA

National Provider Directory

National Provider Directory

Locations

1605 116th Ave NE
Ste 110
Bellevue, WA 98004
Phone (425) 450-9801

1975 112th Ave NE
Ste 100
Bellevue, WA 98004
Phone (425) 450-9801

1260 116th Ave NE
Ste 200
Bellevue, WA 98004
Phone (425) 450-9801

12501 NE Bel Red Rd
Ste 100
Bellevue, WA 98005
Phone (425) 450-9778

Practitioners & affiliated clinicians

Practitioners 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720656000000",
    "number": "1285718015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 116TH AVE NE",
            "address_2": "SUITE 110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980043034",
            "telephone_number": "425-450-9801",
            "fax_number": "425-450-9778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 112TH AVE NE STE 100",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980042942",
            "telephone_number": "425-450-9801",
            "fax_number": "425-450-9778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLEVUE SPORTS & SPINE PHYSICAL THERAPY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A",
        "authorized_official_last_name": "KOWALINSKI",
        "authorized_official_first_name": "RUSSELL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-450-9801",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peak Sports & Spine Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.