NPIMap

Organization Active NPI

Renton Sports & Spine PT

  • Physical Therapist
  • Kent, WA
National Provider Identifier
1326048364
Registry record updated Jul 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00002862 Issued in WA
Legal business name
RENTON SPORTS & SPINE PT
Doing business as
Renton Sports & Spine PT
Practice address
19400 108TH Ave SE
Suite 100
Kent, WA 98031-0108
Phone
(425) 917-9885
Fax
(253) 277-0737
NPI assigned
Jul 29, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2016

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

Authorized official

Name
Mr. Joel M Johnson, PTNPI 1811060502
Title
Physical Therapist/Clinci Director
Phone
(425) 917-9885

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00002862 WA Primary

Addresses

Primary practice location

19400 108TH Ave SE
Suite 100
Kent, WA 98031-0108

Mailing address

19400 108TH Ave SE
Suite 100
Kent, WA 98031-0108
Phone (425) 917-9885

Other identifiers 6

IdentifierTypeStateIssuer
7293608OtherCIGNA
8351397MedicaidWA
650021468OtherRR MEDICARE
147035OtherWADEPT OF VTT
4465984OtherAETNA
5324J0OtherWAREGENCE BS

Other names 1

  • Renton Sports & Spine PT Doing business as

National Provider Directory

National Provider Directory

Locations

19400 108th Ave SE
Ste 100
Kent, WA 98031
Phone (425) 272-0252

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468368000000",
    "number": "1326048364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19400 108TH AVE SE",
            "address_2": "SUITE 100",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980310108",
            "telephone_number": "425-917-9885",
            "fax_number": "253-277-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19400 108TH AVE SE",
            "address_2": "SUITE 100",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980310108",
            "telephone_number": "425-917-9885",
            "fax_number": "253-277-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENTON SPORTS & SPINE PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2016-07-13",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/CLINCI DIRECTOR",
        "authorized_official_telephone_number": "425-917-9885",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00002862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "7293608",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8351397",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "650021468",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF VTT",
            "identifier": "147035",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4465984",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS",
            "identifier": "5324J0",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Renton Sports & Spine PT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kent, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.