Proliance Surgeons Inc., P.S.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

601484763 Issued in WA

Legal business name

PROLIANCE SURGEONS INC., P.S.

Practice address

8009 S 180TH St
Suite 112
Kent, WA 98032-1042

Phone

(425) 226-7827

Fax

(425) 251-5757

NPI assigned

Jun 14, 2006

Organization subpart

Yes

Parent organization

PROLIANCE SURGEONS INC., P.S.As reported in NPPES

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

Authorized official

Name

Mr. David G. Fitzgerald

Title

Ceo

Phone

(206) 838-2599

Specialties & licenses 2

Addresses

Other names 1

• STAR Sports Therapy and Athletic Rehabilitation Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Part of

Orthopedic Physicians

Locations

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217548800000",
    "number": "1417990888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 OLIVE WAY",
            "address_2": "SUITE 1505",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011878",
            "telephone_number": "206-838-2590",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8009 S 180TH ST",
            "address_2": "SUITE 112",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980321042",
            "telephone_number": "425-226-7827",
            "fax_number": "425-251-5757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIANCE SURGEONS INC., P.S.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROLIANCE SURGEONS INC., P.S.",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-08-01",
        "status": "A",
        "authorized_official_last_name": "FITZGERALD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-838-2599",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "601484763",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WA",
            "license": "601484763",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "STAR Sports Therapy and Athletic Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kristine Marie Proctor, LMP,MMP
• Proliance Surgeons, Inc., P.S.
• Jennifer Brooke Prudhomme, CPM-TN
• Public Hospital District #1 of King County
• Raychel Puga Reynoso
• Puget Sound Drug Corporation

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2008; 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.