NPIMap

Organization Active NPI

Woodland Creek Physical Therapy LLC

  • Specialist
  • Lacey, WA
National Provider Identifier
1578640124
Registry record updated May 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
WOODLAND CREEK PHYSICAL THERAPY LLC
Practice address
5205 Corporate Center CT SE
Suite C
Lacey, WA 98503-5901
Phone
(360) 412-1367
Fax
(360) 412-1391
NPI assigned
Nov 1, 2006
Last updated
May 19, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2014

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

Authorized official

Name
Mr. Scott O. Ensign, MPT, JSCCNPI 1205814266
Title
Owner
Phone
(360) 412-1367

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 602 027 552 WA
Specialist 174400000X NU Primary

Addresses

Primary practice location

5205 Corporate Center CT SE
Suite C
Lacey, WA 98503-5901

Mailing address

5205 Corporate Center CT SE
Suite C
Lacey, WA 98503-5901
Phone (360) 412-1368

Other identifiers 1

IdentifierTypeStateIssuer
7102437MedicaidWA

National Provider Directory

National Provider Directory

Locations

1222 Carpenter Rd SE
Ste A1
Lacey, WA 98503
Phone (360) 412-1367

5205 Corporate Center Ct SE
Lacey, WA 98503
Phone (360) 412-1367

5205 Corporate Center Ct SE
#C
Lacey, WA 98503
Phone (360) 412-1367

Practitioners & affiliated clinicians

Practitioners 2

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400457600000",
    "number": "1578640124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5205 CORPORATE CENTER CT SE",
            "address_2": "SUITE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035901",
            "telephone_number": "360-412-1368",
            "fax_number": "360-412-1391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5205 CORPORATE CENTER CT SE",
            "address_2": "SUITE C",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985035901",
            "telephone_number": "360-412-1367",
            "fax_number": "360-412-1391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND CREEK PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2014-05-19",
        "status": "A",
        "authorized_official_last_name": "ENSIGN",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-412-1367",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, JSCC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "602 027 552",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7102437",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lacey, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2014; 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.