Game Changer Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

GAME CHANGER PHYSICAL THERAPY LLC

Practice address

5020 W Clearwater Ave
Kennewick, WA 99336-1951

Phone

(509) 934-3309

Fax

(509) 852-7566

NPI assigned

Sep 6, 2022

Last updated

Sep 6, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kacie Michelle Shively, PT, DPTNPI 1811516297

Title

Owner/Physical Therapist

Phone

(509) 947-8600

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kacie Michelle Shively, PT, DPT, ACSM-EP

  • Physical Therapist
  • Kennewick, WA
  • NPI 1811516297
  NPD Authorized official

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

{
    "created_epoch": "1662422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662422400000",
    "number": "1497476691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 S TEXAS ST",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993364085",
            "telephone_number": "509-934-3309",
            "fax_number": "509-852-7566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5020 W CLEARWATER AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993361951",
            "telephone_number": "509-934-3309",
            "fax_number": "509-852-7566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAME CHANGER PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-06",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A",
        "authorized_official_last_name": "SHIVELY",
        "authorized_official_first_name": "KACIE",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "509-947-8600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aaron L Galey, RPH
• Pamela Gallardo
• Garrett William Gallinger, DMD
• Rebeca Galvez, CPC
• Eric O Gamboa, MD
• Adilene Garcia
• Alejandra Garcia
• Andres Garcia Jr., PA-C
• Anthony Garcia
• Crystal Marie Garcia

• Physical Therapy Clinic/Center in Kennewick, WA
• Providers in Kennewick, WA by specialty
• Physical Therapy Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; 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.