NPIMap

Organization Active NPI

Eagle Rock Physical Therapy PLLC

  • Physical Therapist
  • Brewster, WA
National Provider Identifier
1649353053
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00003294 Issued in WA
Legal business name
EAGLE ROCK PHYSICAL THERAPY PLLC
Practice address
411 Hospital Way
Brewster, WA 98812
Phone
(509) 689-4301
Fax
(509) 689-4307
NPI assigned
Oct 23, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Lisa Diane Sonneman, PTNPI 1699840595
Title
Co Owner Authorized Official
Phone
(509) 689-4301

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT00006129 WA
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X PT00003294 WA Primary

Addresses

Primary practice location

411 Hospital Way
Brewster, WA 98812

Mailing address

PO Box 769
411 Hospital Way
Brewster, WA 98812
Phone (509) 689-4301

Other identifiers 5

IdentifierTypeStateIssuer
8323479MedicaidWA
8374126MedicaidWA
0206563OtherWVL & I BRIAN
0206566OtherWAL & I USR
8374126OtherUNITED MEDICAL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1161561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1649353053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 769",
            "address_2": "411 HOSPITAL WAY",
            "city": "BREWSTER",
            "state": "WA",
            "postal_code": "98812",
            "telephone_number": "509-689-4301",
            "fax_number": "509-689-4307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 HOSPITAL WAY",
            "city": "BREWSTER",
            "state": "WA",
            "postal_code": "98812",
            "telephone_number": "509-689-4301",
            "fax_number": "509-689-4307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE ROCK PHYSICAL THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SONNEMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "CO OWNER AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "509-689-4301",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00006129",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00003294",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8323479",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8374126",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I  BRIAN",
            "identifier": "0206563",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I  USR",
            "identifier": "0206566",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED MEDICAL",
            "identifier": "8374126",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brewster, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.