NPIMap

Organization Active NPI

Kitsap Physical Therapy and Sports Clinic PS Inc

  • Durable Medical Equipment & Medical Supplies
  • Silverdale, WA
National Provider Identifier
1699355446
Registry record updated May 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC
Practice address
2400 NW Myhre Rd Ste 102
Silverdale, WA 98383-7672
Phone
(606) 131-8343
NPI assigned
Apr 14, 2021
Last updated
May 10, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
KITSAP PHYSICAL THERAPY AND SPORTS CLINICS PS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 10, 2021

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

Authorized official

Name
Summer Zumwalt
Title
HRD
Phone
(360) 598-3764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

2400 NW Myhre Rd Ste 102
Silverdale, WA 98383-7672

Mailing address

2400 NW Myhre Rd Ste 101
Silverdale, WA 98383-7672
Phone (360) 598-3764

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210316002553 WA DME Supplier - Independently-Practicing Occupational TherapistDME Supplier - Independently-Practicing Physical Therapist 6507762333 1 other NPI on this enrollment
Practice locations: Silverdale, WA

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Kitsap PT Sports Clin

NPI Registry JSON

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

{
    "created_epoch": "1618358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620604800000",
    "number": "1699355446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 NW MYHRE RD STE 101",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983837672",
            "telephone_number": "360-598-3764",
            "fax_number": "360-598-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 NW MYHRE RD STE 102",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983837672",
            "telephone_number": "606-131-8343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITSAP PHYSICAL THERAPY AND SPORTS CLINIC PS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KITSAP PHYSICAL THERAPY AND SPORTS CLINICS PS INC",
        "enumeration_date": "2021-04-14",
        "last_updated": "2021-05-10",
        "certification_date": "2021-05-10",
        "status": "A",
        "authorized_official_last_name": "ZUMWALT",
        "authorized_official_first_name": "SUMMER",
        "authorized_official_title_or_position": "HRD",
        "authorized_official_telephone_number": "360-598-3764"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Silverdale, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2021; 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.