NPIMap

Organization Active NPI

Balance Physical Therapy Inc, P.S.

  • Physical Therapist
  • Issaquah, WA
National Provider Identifier
1710197090
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00006853 Issued in WA
Legal business name
BALANCE PHYSICAL THERAPY INC, P.S.
Practice address
730 NW Gilman Blvd
Suite C108
Issaquah, WA 98027-5326
Phone
(425) 391-6794
Fax
(425) 391-1525
NPI assigned
May 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Karen E. Shrader Dasilva, PTNPI 1679793061
Title
Ceo
Phone
(425) 391-6794

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X PT00006853 WA Primary

Addresses

Primary practice location

730 NW Gilman Blvd
Suite C108
Issaquah, WA 98027-5326

Mailing address

730 NW Gilman Blvd
Suite C108
Issaquah, WA 98027-5326
Phone (425) 391-6794

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040406001481 WA Part B Supplier - Clinic/Group Practice 2567455470 Receives reassigned benefits from 6 practitioners
Practice locations: Issaquah, WA

National Provider Directory

National Provider Directory

Locations

730 NW Gilman Blvd
Ste C108
Issaquah, WA 98027
Phone (425) 391-6794

Practitioners & affiliated clinicians

Practitioners 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1710197090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 NW GILMAN BLVD",
            "address_2": "SUITE C108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275326",
            "telephone_number": "425-391-6794",
            "fax_number": "425-391-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 NW GILMAN BLVD",
            "address_2": "SUITE C108",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980275326",
            "telephone_number": "425-391-6794",
            "fax_number": "425-391-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALANCE PHYSICAL THERAPY INC, P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "SHRADER DASILVA",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-391-6794",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00006853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Issaquah, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; 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.