Active NPI
Myke Clarisse Urbiztondo Vinson, PT
- Physical Therapist
- Richland, WA
National Provider Identifier
1295348043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT61012769
- Practice address
- 1745 Pike Ave
Richland, WA 99354-2295 - Phone
- (509) 946-8095
- NPI assigned
- Aug 30, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT61012769 | WA | Primary |
Addresses
Primary practice location
1745 Pike Ave
Richland, WA 99354-2295
Mailing address
25117 SW Parkway Ave Ste D
Wilsonville, OR 97070-9697
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT61012769 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598745600000",
"number": "1295348043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "25117 SW PARKWAY AVE STE D",
"city": "WILSONVILLE",
"state": "OR",
"postal_code": "970709697"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1745 PIKE AVE",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993542295",
"telephone_number": "509-946-8095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINSON",
"first_name": "MYKE CLARISSE",
"middle_name": "URBIZTONDO",
"name_prefix": "Miss",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-08-30",
"last_updated": "2020-08-30",
"certification_date": "2020-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT61012769",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.