Northwest Sport and Spine Physical Therapy

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

PT60693079 Issued in WA

Legal business name

NORTHWEST SPORT AND SPINE PHYSICAL THERAPY

Practice address

17788 147TH St SE
Monroe, WA 98272-1030

Phone

(360) 464-4358

NPI assigned

Mar 19, 2018

Organization subpart

No

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

Authorized official

Name

Sean O'Kelley, BS, DPT

Title

Owner/Physical Therapist

Phone

(360) 464-4358

Specialties & licenses 1

Addresses

Other names 1

• Northwest Sport and Spine Physical Therapy-Mt Vernon Doing business as

Locations

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521417600000",
    "number": "1487158259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17788 147TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721030",
            "telephone_number": "360-464-4358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17788 147TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721030",
            "telephone_number": "360-464-4358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "525 E College Way",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "WA",
            "postal_code": "982735571",
            "country_code": "US",
            "telephone_number": "360-464-4358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "NORTHWEST SPORT AND SPINE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-03-19",
        "status": "A",
        "authorized_official_last_name": "O'KELLEY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "360-464-4358",
        "authorized_official_credential": "BS, DPT"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "PT60693079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Sport and Spine Physical Therapy-Mt Vernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Nichols, LMP
• Jennette Nielsen
• Debbie Ann Noeske, RPH
• Christopher Masahiro Nomura, PHARMD.
• Northland Hearing Center, Inc.
• Ashley Ann Nustad, M.S., CCC-SLP
• Darlene Sue O'Grady, OTR/L
• Jacob R O'Neill, CPC
• Shaeniah L Ochoa
• Chris Officer, LMP

• Physical Medicine & Rehabilitation Physician in Monroe, WA
• Providers in Monroe, WA by specialty
• Physical Medicine & Rehabilitation Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.