Court Club Physical Therapy, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

COURT CLUB PHYSICAL THERAPY, LLC

Doing business as

Physical Therapy @ the Pacific Clinic

Practice address

1350 N Grant St
Kennewick, WA 99336-1355

Phone

(509) 735-2014

Fax

(509) 735-3980

NPI assigned

Jun 1, 2007

Organization subpart

No

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

Authorized official

Name

Theresa Ann Kliphardt

Title

Clinic Manager

Phone

(509) 735-2014

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Physical Therapy @ the Pacific Clinic Doing business as

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610064000000",
    "number": "1346442449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 N GRANT ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993361355",
            "telephone_number": "509-735-2014",
            "fax_number": "509-735-3980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N GRANT ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993361355",
            "telephone_number": "509-735-2014",
            "fax_number": "509-735-3980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COURT CLUB PHYSICAL THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "KLIPHARDT",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CLINIC MANAGER",
        "authorized_official_telephone_number": "509-735-2014"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7119324",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physical Therapy @ the Pacific Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Specialist in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2021; 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.