NPIMap

Organization Active NPI

Pacific Northwest Physical Therapy

  • Physical Therapist
  • Crescent City, CA
National Provider Identifier
1619215407
Registry record updated Jan 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 23616 Issued in CA
Legal business name
PACIFIC NORTHWEST PHYSICAL THERAPY
Practice address
200 US Highway 101 N
Crescent City, CA 95531-2844
Phone
(707) 464-9511
NPI assigned
Jan 29, 2013
Last updated
Jan 29, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2013

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

Authorized official

Name
Brad Kime, P.T.
Title
Owner
Phone
(707) 464-9511

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 23616 CA Primary

Addresses

Primary practice location

200 US Highway 101 N
Crescent City, CA 95531-2844

Mailing address

200 US Highway 101 N
Crescent City, CA 95531-2844
Phone (707) 464-9511

National Provider Directory

National Provider Directory
Tax ID family
Kime Bradley R2 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

200 US Highway 101 N
Crescent City, CA 95531
Phone (707) 464-9511

225 I St
Crescent City, CA 95531
Phone (707) 464-9511

Practitioners & affiliated clinicians

Practitioners 8

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": "1359417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359417600000",
    "number": "1619215407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 US HIGHWAY 101 N",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955312844",
            "telephone_number": "707-464-9511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 US HIGHWAY 101 N",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955312844",
            "telephone_number": "707-464-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC NORTHWEST PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-29",
        "last_updated": "2013-01-29",
        "status": "A",
        "authorized_official_last_name": "KIME",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-464-9511",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 23616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.