Renton Sports & Spine PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00009406 Issued in WA

Legal business name

RENTON SPORTS & SPINE PT

Practice address

4361 Talbot Rd S
Ste 100
Renton, WA 98055-6226

Phone

(425) 917-9885

Fax

(425) 917-2334

NPI assigned

Aug 1, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Joel M Johnson, PT

Title

Physical Therapist/Clinic

Phone

(425) 917-9885

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Renton Sports Spine PT2 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.

• Renton Sports & Spine PT

  • Physical Therapist
  • Renton, WA
  • NPI 1528068533
  NPD tax ID

Locations

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

{
    "created_epoch": "1122854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1437159449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4361 TALBOT RD S",
            "address_2": "STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556226",
            "telephone_number": "425-917-9885",
            "fax_number": "425-917-2334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4361 TALBOT RD S",
            "address_2": "STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980556226",
            "telephone_number": "425-917-9885",
            "fax_number": "425-917-2334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENTON SPORTS & SPINE PT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/CLINIC",
        "authorized_official_telephone_number": "425-917-9885",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00009406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "0165699",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Renton Smiles, LLC
• Renton SNF Healthcare LLC
• Renton Spa
• Renton Spine and Sports Medicine LLC
• Renton Spine Clinic
• Renton Sports & Spine PT
• Renton Vision Clinic PLLC
• Zachary Renzetti, SUDP/T
• Restore Health & Body Wisdom, PLLC
• Restore Vision Centers

• Physical Therapist in Renton, WA
• Providers in Renton, 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 22, 2020; 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.