NPIMap

Organization Active NPI

Peak Fitness Physical Therapy, PS

  • Physical Therapist
  • Davenport, WA
National Provider Identifier
1447384235
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00006484 Issued in WA
Legal business name
PEAK FITNESS PHYSICAL THERAPY, PS
Practice address
506 Morgan Street
Davenport, WA 99122-0752
Phone
(509) 725-7325
Fax
(509) 725-5325
NPI assigned
Mar 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Michael G Van Pevenage, RPTNPI 1184789703
Title
President
Phone
(509) 725-7325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00006484 WA Primary

Addresses

Primary practice location

506 Morgan Street
Davenport, WA 99122-0752

Mailing address

PO Box 752
Davenport, WA 99122-0752
Phone (509) 725-7325

Other identifiers 3

IdentifierTypeStateIssuer
7125768MedicaidWA
P00335661OtherWAPALMETTO
0205378OtherWAL & I

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1447384235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 752",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991220752",
            "telephone_number": "509-725-7325",
            "fax_number": "509-725-5325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 MORGAN STREET",
            "city": "DAVENPORT",
            "state": "WA",
            "postal_code": "991220752",
            "telephone_number": "509-725-7325",
            "fax_number": "509-725-5325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEAK FITNESS PHYSICAL THERAPY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "VAN PEVENAGE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-725-7325",
        "authorized_official_credential": "RPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00006484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7125768",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO",
            "identifier": "P00335661",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0205378",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Davenport, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.