NPIMap

Organization Active NPI

Sumner Specialized Physical Therapy, PLLC

  • Physical Therapist
  • Colville, WA
National Provider Identifier
1457878035
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00010199 Issued in WA
Legal business name
SUMNER SPECIALIZED PHYSICAL THERAPY, PLLC
Practice address
212 W Birch Ave
Colville, WA 99114-2440
Phone
(509) 684-5621
Fax
(509) 684-7943
NPI assigned
Aug 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Robert David Sumner, DPTNPI 1184634560
Title
Owner/DPT
Phone
(509) 684-5621

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00010199 WA Primary
Orthopedic Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 2251X0800X PT00010199 WA

Addresses

Primary practice location

212 W Birch Ave
Colville, WA 99114-2440

Mailing address

212 W Birch Ave
Colville, WA 99114-2440
Phone (509) 684-5621

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171005002699 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4385919091 Receives reassigned benefits from 3 practitioners
Practice locations: Colville, WA

National Provider Directory

National Provider Directory

Locations

212 W Birch Ave
Colville, WA 99114
Phone (509) 684-5621

Practitioners & affiliated clinicians

Practitioners 4

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": "1503532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1457878035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W BIRCH AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142440",
            "telephone_number": "509-684-5621",
            "fax_number": "509-684-7943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W BIRCH AVE",
            "city": "COLVILLE",
            "state": "WA",
            "postal_code": "991142440",
            "telephone_number": "509-684-5621",
            "fax_number": "509-684-7943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMNER SPECIALIZED PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SUMNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER/DPT",
        "authorized_official_telephone_number": "509-684-5621",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00010199",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WA",
            "license": "PT00010199",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colville, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.