NPIMap

Organization Active NPI

Yelm Physical Therapy Services Inc PS

  • Physical Therapist
  • Yelm, WA
National Provider Identifier
1639595085
Registry record updated Nov 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
YELM PHYSICAL THERAPY SERVICES INC PS
Doing business as
Yelm Physical Therapy
Practice address
417 W Yelm Ave
Yelm, WA 98597-7679
Phone
(360) 458-2444
Fax
(360) 458-2747
NPI assigned
Mar 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2025

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

Authorized official

Name
Shirley A Provoznik
Title
Operations Manager
Phone
(360) 338-0181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

417 W Yelm Ave
Yelm, WA 98597-7679

Mailing address

100 Dennis St SW Ste B
Tumwater, WA 98501-6523
Phone (360) 458-2444

Other names 1

  • Yelm 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
O20140903001249 WA Part B Supplier - Clinic/Group Practice 5395963490 Receives reassigned benefits from 11 practitioners
Practice locations: Yelm, WA

National Provider Directory

National Provider Directory

Locations

514 Yelm Ave W
Yelm, WA 98597
Phone (360) 458-2225

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1394409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762214400000",
    "number": "1639595085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 DENNIS ST SW STE B",
            "city": "TUMWATER",
            "state": "WA",
            "postal_code": "985016523",
            "telephone_number": "360-458-2444",
            "fax_number": "360-458-2747"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 W YELM AVE",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985977679",
            "telephone_number": "360-458-2444",
            "fax_number": "360-458-2747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YELM PHYSICAL THERAPY SERVICES INC PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-10",
        "last_updated": "2025-11-04",
        "certification_date": "2025-11-04",
        "status": "A",
        "authorized_official_last_name": "PROVOZNIK",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "360-338-0181"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Yelm Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Yelm Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Yelm, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2025; 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.