NPIMap

Organization Active NPI

Deer Park Physical Therapy Inc

  • Physical Therapist
  • Deer Park, WA
National Provider Identifier
1306903182
Registry record updated Jan 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00002482 Issued in WA
Legal business name
DEER PARK PHYSICAL THERAPY INC
Practice address
707 S Park St
Deer Park, WA 99006-0948
Phone
(509) 276-8811
Fax
(866) 629-4801
NPI assigned
Jan 2, 2007
Last updated
Jan 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2013

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

Authorized official

Name
Mr. Daniel W Roberts, P.T.NPI 1295738813
Title
Owner
Phone
(509) 276-8811

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00002482 WA Primary

Addresses

Primary practice location

707 S Park St
Deer Park, WA 99006-0948

Mailing address

707 S Park St
Deer Park, WA 99006-0948
Phone (509) 276-8811

Other identifiers 1

IdentifierTypeStateIssuer
7000474MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000788 WA Part B Supplier - Clinic/Group Practice 6103716840 Receives reassigned benefits from 11 practitioners
Practice locations: Deer Park, WA

National Provider Directory

National Provider Directory

Locations

707 S Park St
Deer Park, WA 99006
Phone (509) 276-8811

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357257600000",
    "number": "1306903182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 S PARK ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990060948",
            "telephone_number": "509-276-8811",
            "fax_number": "866-629-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 S PARK ST",
            "city": "DEER PARK",
            "state": "WA",
            "postal_code": "990060948",
            "telephone_number": "509-276-8811",
            "fax_number": "866-629-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER PARK PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2013-01-04",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-276-8811",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00002482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000474",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; 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.