Active NPI
Andrew Wodka, BS,PT, MBA
- Physical Therapist
- Tumwater, WA
National Provider Identifier
1689746364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT00009524
- Practice address
- 100 Dennis St SW
Suite a
Tumwater, WA 98501-6523 - Phone
- (360) 704-3300
- Fax
- (360) 704-7676
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT00009524 | WA | Primary |
Addresses
Primary practice location
100 Dennis St SW
Suite a
Tumwater, WA 98501-6523
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 192512 | Other | WA | DEPT OF LABOR & INDUSTRY |
| P00208864 | Other | WA | RAILROAD MEDICARE |
| 3757WO | Other | WA | REGENCE BLUE SHIELD |
| 8939766 | Other | WA | CRIME VICTIMS |
| 8413882 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Bachelor of Science, Master of Business Administration
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT00009524 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437177600000",
"number": "1689746364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223",
"fax_number": "630-759-9510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 DENNIS ST SW",
"address_2": "SUITE A",
"city": "TUMWATER",
"state": "WA",
"postal_code": "985016523",
"telephone_number": "360-704-3300",
"fax_number": "360-704-7676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WODKA",
"first_name": "ANDREW",
"credential": "BS,PT, MBA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2015-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT00009524",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR & INDUSTRY",
"identifier": "192512",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00208864",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD",
"identifier": "3757WO",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8939766",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8413882",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tumwater, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.