NPIMap

Organization Active NPI

Bonney Lake Physical Therapy and Hand Rehab, PLLC

  • Physical Therapist
  • Bonney Lake, WA
National Provider Identifier
1558509786
Registry record updated Jan 19, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT5418 Issued in WA
Legal business name
BONNEY LAKE PHYSICAL THERAPY AND HAND REHAB, PLLC
Practice address
20910 State Route 410 E
Bonney Lake, WA 98391-6302
Phone
(253) 862-2575
Fax
(253) 862-2675
NPI assigned
Jan 26, 2009
Last updated
Jan 19, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2015

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

Authorized official

Name
Mr. Michael Andrew Egbert, PTNPI 1093897613
Title
President
Phone
(253) 862-2575

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT5418 WA Primary
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X PT5418 WA
Hand Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XH1200X OT2499 WA
Physical Rehabilitation Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0019X OT2499 WA

Addresses

Primary practice location

20910 State Route 410 E
Bonney Lake, WA 98391-6302

Mailing address

20910 State Route 410 E
Bonney Lake, WA 98391-6302
Phone (253) 862-2575

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090326000358 WA Part B Supplier - Clinic/Group Practice 8820155435 Receives reassigned benefits from 6 practitioners
Practice locations: Bonney Lake, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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": "1232928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421625600000",
    "number": "1558509786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20910 STATE ROUTE 410 E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916302",
            "telephone_number": "253-862-2575",
            "fax_number": "253-862-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20910 STATE ROUTE 410 E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916302",
            "telephone_number": "253-862-2575",
            "fax_number": "253-862-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEY LAKE PHYSICAL THERAPY AND HAND REHAB, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-26",
        "last_updated": "2015-01-19",
        "status": "A",
        "authorized_official_last_name": "EGBERT",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "253-862-2575",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT5418",
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WA",
            "license": "PT5418",
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Hand",
            "state": "WA",
            "license": "OT2499",
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": "WA",
            "license": "OT2499",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2015; 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.