NPIMap

Organization Active NPI

Pacific Physical Therapy PLLC

  • Physical Therapy Clinic/Center
  • Port Orchard, WA
National Provider Identifier
1588098305
Registry record updated Dec 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT60392890 Issued in WA
Legal business name
PACIFIC PHYSICAL THERAPY PLLC
Practice address
1950 Pottery Ave Ste 110
Port Orchard, WA 98366-2501
Phone
(360) 329-7052
Fax
(360) 329-7053
NPI assigned
Aug 28, 2013
Last updated
Dec 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2014

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

Authorized official

Name
Brett Douglas Palmer, PTNPI 1679908677
Title
Managing Member
Phone
(360) 329-7052

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 Therapy Clinic/Center 261QP2000X PT60392890 WA Primary

Addresses

Primary practice location

1950 Pottery Ave Ste 110
Port Orchard, WA 98366-2501

Mailing address

1950 Pottery Ave Ste 110
Port Orchard, WA 98366-2501
Phone (360) 329-7052

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140828002247 WA Part B Supplier - Clinic/Group Practice 9335374313 Receives reassigned benefits from 14 practitioners
Practice locations: Silverdale, WA; Port Orchard, WA

National Provider Directory

National Provider Directory
Tax ID family
Pacific Physical Therapy PLLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3114 NW Randall Way
Ste D2A
Silverdale, WA 98383
Phone (360) 625-9161

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418601600000",
    "number": "1588098305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 POTTERY AVE STE 110",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662501",
            "telephone_number": "360-329-7052",
            "fax_number": "360-329-7053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 POTTERY AVE STE 110",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662501",
            "telephone_number": "360-329-7052",
            "fax_number": "360-329-7053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2014-12-15",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "BRETT",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "360-329-7052",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "PT60392890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2014; 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.