Valley Physical Therapy PS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00008466 Issued in WA

Legal business name

VALLEY PHYSICAL THERAPY PS

Practice address

433 Elm Street
Clarkston, WA 99403-2650

Phone

(509) 758-5647

Fax

(509) 758-5648

NPI assigned

Jan 30, 2007

Last updated

Sep 3, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brooksie K Larson, MPTNPI 1033395322

Title

Owner President

Phone

(509) 758-5647

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

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.

• Brooksie K Larson

  • Physical Therapist
  • Clarkston, WA
  • NPI 1033395322
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409702400000",
    "number": "1417093048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "433 ELM STREET",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032650",
            "telephone_number": "509-758-5647",
            "fax_number": "509-758-5648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 ELM STREET",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032650",
            "telephone_number": "509-758-5647",
            "fax_number": "509-758-5648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VALLEY PHYSICAL THERAPY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2014-09-03",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "BROOKSIE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "509-758-5647",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT1411",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00008466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8379778",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805941300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2014; 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.