Individual provider Active NPI

Grant M Lundberg, DPT

  • Physical Therapist
  • Spokane, WA
National Provider Identifier
1619261906
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60725120 Issued in WA
Practice address
5905 N Mayfair St Ste 100
Spokane, WA 99208-1127
Phone
(509) 462-8010
NPI assigned
Jun 3, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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 PT60725120 WA Primary

Addresses

Primary practice location

5905 N Mayfair St Ste 100
Spokane, WA 99208-1127

Mailing address

5905 N Mayfair St Ste 100
Spokane, WA 99208-1127
Phone (509) 462-8010

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170315001740 WA Practitioner - Physical Therapist in Private Practice 5799954178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5905 N Mayfair St
Suite 100
Spokane, WA 99208-1127
Phone (509) 462-8010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Inspire Physical & Hand Therapy Spokane Inc. P.S. Physical Therapist CurrentSince Oct 1, 2018 Accepting new patients
Inspire Physical & Hand Therapy Spokane Inc. P.S. Past Accepting new patients

Locations

601 W 5th Ave
Ste 308
Spokane, WA 99204
Phone (509) 413-2495

5905 N Mayfair St
#100
Spokane, WA 99208
Phone (509) 315-9155

12410 E Sinto Ave
Ste 205
Spokane Valley, WA 99216
Phone (509) 242-3944

100 Dennis St SW
Ste B
Tumwater, WA 98501
Phone (360) 338-0181

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": "1307059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1619261906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5905 N MAYFAIR ST STE 100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081127",
            "telephone_number": "509-462-8010",
            "fax_number": "509-462-8011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5905 N MAYFAIR ST STE 100",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992081127",
            "telephone_number": "509-462-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUNDBERG",
        "first_name": "GRANT",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-03",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60725120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.