Individual provider Active NPI

Zane Wise, DPT

  • Physical Therapist
  • Chehalis, WA
National Provider Identifier
1609305176
Registry record updated Jul 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT61320923 Issued in WA
Practice address
1817 S Market Blvd Ste C
Chehalis, WA 98532-4100
Phone
(360) 996-4410
Fax
(360) 996-4466
NPI assigned
Jun 8, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT61320923 WA Primary

Addresses

Primary practice location

1817 S Market Blvd Ste C
Chehalis, WA 98532-4100

Mailing address

3270 Liberty Rd S
Salem, OR 97302
Phone (503) 371-0779

Other practice location 1

1118 View Ave
Centralia, WA 98531-1870
Phone (360) 736-5273

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220901003694 WA Practitioner - Physical Therapist in Private Practice 7113298118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centralia Physical Therapy Inc PSGroup PAC ID 0648429688, 20 clinicians

Practice addresses (Care Compare)

1817 S Market Blvd
Suite C
Chehalis, WA 98532-4100
Phone (360) 996-4410

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Centralia Physical Therapy Inc PS Physical Therapist CurrentSince Sep 6, 2022 Accepting new patients
Aeroflow Connect LLC PastSince Sep 6, 2022 Accepting new patients

Locations

1316 Mt Saint Helens Way NE
Ste B
Castle Rock, WA 98611
Phone (360) 557-8020

1118 View Ave
Centralia, WA 98531
Phone (360) 736-5273

1817 S Market Blvd
Ste C
Chehalis, WA 98532
Phone (360) 996-4410

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1609305176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3270 LIBERTY RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "97302",
            "telephone_number": "503-371-0779",
            "fax_number": "503-371-0886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1817 S MARKET BLVD STE C",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985324100",
            "telephone_number": "360-996-4410",
            "fax_number": "360-996-4466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1118 View Ave",
            "address_purpose": "LOCATION",
            "city": "Centralia",
            "state": "WA",
            "postal_code": "985311870",
            "country_code": "US",
            "telephone_number": "360-736-5273",
            "fax_number": "360-736-5053",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WISE",
        "first_name": "ZANE",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-08",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT61320923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chehalis, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.