NPIMap

Organization Active NPI

G4 Athlete LLC

Doing business as G4 Athlete

  • Sports Physical Therapist
  • Mercer Island, WA
National Provider Identifier
1740689520
Registry record updated Aug 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
603186027 Issued in WA
Legal business name
G4 ATHLETE LLC
Doing business as
G4 Athlete
Practice address
2737 77TH Ave SE
Suite 214
Mercer Island, WA 98040-2830
Phone
(206) 518-9405
Fax
(855) 819-0086
NPI assigned
Aug 18, 2014
Last updated
Aug 18, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2014

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

Authorized official

Name
Mr. Brent M George, MPTNPI 1649252164
Title
Physical Therapist/Clinic Owner
Phone
(206) 518-9405

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
Sports Physical Therapist 2251S0007X 603186027 WA Primary

Addresses

Primary practice location

2737 77TH Ave SE
Suite 214
Mercer Island, WA 98040-2830

Mailing address

2737 77TH Ave SE
Suite 214
Mercer Island, WA 98040-2830
Phone (206) 518-9405

Other names 1

  • G4 Athlete Doing business as

National Provider Directory

National Provider Directory

Locations

2737 77th Ave SE
Ste 214
Mercer Island, WA 98040
Phone (206) 518-9405

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1408320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1408320000000",
    "number": "1740689520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2737 77TH AVE SE",
            "address_2": "SUITE 214",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402830",
            "telephone_number": "206-518-9405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2737 77TH AVE SE",
            "address_2": "SUITE 214",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "980402830",
            "telephone_number": "206-518-9405",
            "fax_number": "855-819-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G4 ATHLETE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-18",
        "last_updated": "2014-08-18",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/CLINIC OWNER",
        "authorized_official_telephone_number": "206-518-9405",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "WA",
            "license": "603186027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "G4 Athlete",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mercer Island, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2014; 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.