NPIMap

Organization Active NPI

Gravelly Lake Physical Therapy, Inc.

  • Physical Therapist
  • University Place, WA
National Provider Identifier
1518176650
Registry record updated Sep 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
GRAVELLY LAKE PHYSICAL THERAPY, INC.
Practice address
3130 Sylvan Dr W
University Place, WA 98466-2514
Phone
(253) 588-2880
NPI assigned
May 22, 2007
Last updated
Sep 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2007

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

Authorized official

Name
Laurie Ann Burkhart, MPTNPI 1154450245
Title
President
Phone
(253) 588-2880

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 Therapist 225100000X WA Primary

Addresses

Primary practice location

3130 Sylvan Dr W
University Place, WA 98466-2514

Mailing address

PO Box 65368
University Place, WA 98464-1368
Phone (253) 588-2880

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190937600000",
    "number": "1518176650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 65368",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984641368",
            "telephone_number": "253-588-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 SYLVAN DR W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984662514",
            "telephone_number": "253-588-2880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAVELLY LAKE PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-09-28",
        "status": "A",
        "authorized_official_last_name": "BURKHART",
        "authorized_official_first_name": "LAURIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-588-2880",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in University Place, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2007; 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.