NPIMap

Organization Active NPI

Physical Therapy Associates PS

  • Physical Medicine & Rehabilitation Physician
  • Spokane, WA
National Provider Identifier
1306985700
Registry record updated Nov 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
L0711669 Issued in WA
Legal business name
PHYSICAL THERAPY ASSOCIATES PS
Practice address
2507 E 27TH Ave
Spokane, WA 99223-4908
Phone
(509) 456-6917
Fax
(509) 456-5902
NPI assigned
Feb 5, 2007
Last updated
Nov 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2012

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

Authorized official

Name
Mrs. Dawn R Ericksen
Title
Office Manager
Phone
(509) 456-6917

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X L0711669 WA Primary

Addresses

Primary practice location

2507 E 27TH Ave
Spokane, WA 99223-4908

Mailing address

2507 E 27TH Ave
Spokane, WA 99223-4908
Phone (509) 456-6917

Other identifiers 2

IdentifierTypeStateIssuer
7081300MedicaidWA
43500OtherDLI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304001128 WA Part B Supplier - Clinic/Group Practice 7810885662 Receives reassigned benefits from 12 practitioners
Practice locations: Spokane, WA

National Provider Directory

National Provider Directory
Tax ID family
Physical Therapy Associates2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

211 W 2nd Ave
Spokane, WA 99201
Phone (509) 456-6917

2507 E 27th Ave
Spokane, WA 99223
Phone (509) 456-6917

3020 S Grand Blvd
Spokane, WA 99203
Phone (509) 456-6717

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354233600000",
    "number": "1306985700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2507 E 27TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992234908",
            "telephone_number": "509-456-6917",
            "fax_number": "509-456-5902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2507 E 27TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992234908",
            "telephone_number": "509-456-6917",
            "fax_number": "509-456-5902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL THERAPY ASSOCIATES PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2012-11-30",
        "status": "A",
        "authorized_official_last_name": "ERICKSEN",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-456-6917",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "L0711669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7081300",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DLI",
            "identifier": "43500",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2012; 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.