NPIMap

Organization Active NPI

Point Fosdick Physical Therapy, Inc PS

Doing business as Harbor Physical Therapy

  • Physical Therapy Clinic/Center
  • Gig Harbor, WA
National Provider Identifier
1609802230
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
601283625 Issued in WA
Legal business name
POINT FOSDICK PHYSICAL THERAPY, INC PS
Doing business as
Harbor Physical Therapy
Practice address
4700 Point Fosdick Drive NW
Suite 213
Gig Harbor, WA 98335
Phone
(253) 851-5718
Fax
(253) 853-6922
NPI assigned
Jun 24, 2006
Last updated
Mar 26, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Authorized official

Name
Mr. Mitchell G Blakney Jr., PTNPI 1104852227
Title
Physical Therapist, Owner
Phone
(253) 851-5718

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
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00002125 WA
Physical Therapy Clinic/Center 261QP2000X 601283625 WA Primary

Addresses

Primary practice location

4700 Point Fosdick Drive NW
Suite 213
Gig Harbor, WA 98335

Mailing address

4700 Point Fosdick Drive NW
Suite 213
Gig Harbor, WA 98335
Phone (253) 851-5718

Other identifiers 1

IdentifierTypeStateIssuer
7095854MedicaidWA

Other names 1

  • Harbor Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040326001389 WA Part B Supplier - Clinic/Group Practice 7810889524 Receives reassigned benefits from 5 practitioners
Practice locations: Gig Harbor, WA

National Provider Directory

National Provider Directory

Locations

4700 Point Fosdick Dr
Ste 213
Gig Harbor, WA 98335
Phone (253) 851-5718

Practitioners & affiliated clinicians

Practitioners 11

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": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364256000000",
    "number": "1609802230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DRIVE NW",
            "address_2": "SUITE 213",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "98335",
            "telephone_number": "253-851-5718",
            "fax_number": "253-853-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 POINT FOSDICK DRIVE NW",
            "address_2": "SUITE 213",
            "city": "GIG HARBOR",
            "state": "WA",
            "postal_code": "98335",
            "telephone_number": "253-851-5718",
            "fax_number": "253-853-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POINT FOSDICK PHYSICAL THERAPY, INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2013-03-26",
        "status": "A",
        "authorized_official_last_name": "BLAKNEY",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST, OWNER",
        "authorized_official_telephone_number": "253-851-5718",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00002125",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "601283625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7095854",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gig Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2013; 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.