NPIMap

Organization Active NPI

Prevail Practices, PLLC

Doing business as Prevail Physical Therapy

  • Physical Therapist
  • Shoreline, WA
National Provider Identifier
1740723915
Registry record updated Nov 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7473 Issued in WA
Legal business name
PREVAIL PRACTICES, PLLC
Doing business as
Prevail Physical Therapy
Practice address
18303 1St Ave NE
Shoreline, WA 98155-3529
Phone
(206) 920-5372
Fax
(866) 329-2785
NPI assigned
Nov 21, 2016
Last updated
Nov 21, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2016

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

Authorized official

Name
Mr. Kenneth Bruk Ballenger, DPT, PTNPI 1538270483
Title
Owner, Manager
Phone
(206) 920-5372

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 7473 WA Primary

Addresses

Primary practice location

18303 1St Ave NE
Shoreline, WA 98155-3529

Mailing address

18303 1St Ave NE
Shoreline, WA 98155-3529
Phone (206) 920-5372

Other names 1

  • Prevail Physical Therapy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180109002747 WA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2163781634 Receives reassigned benefits from 16 practitioners
Practice locations: Shoreline, WA

National Provider Directory

National Provider Directory

Locations

17012 Aurora Ave N
Shoreline, WA 98133
Phone (206) 788-8807

19022 Aurora Ave N
Ste B
Shoreline, WA 98133
Phone (206) 788-8807

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479686400000",
    "number": "1740723915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18303 1ST AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981553529",
            "telephone_number": "206-920-5372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18303 1ST AVE NE",
            "city": "SHORELINE",
            "state": "WA",
            "postal_code": "981553529",
            "telephone_number": "206-920-5372",
            "fax_number": "866-329-2785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREVAIL PRACTICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2016-11-21",
        "status": "A",
        "authorized_official_last_name": "BALLENGER",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "BRUK",
        "authorized_official_title_or_position": "OWNER, MANAGER",
        "authorized_official_telephone_number": "206-920-5372",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DPT, PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "7473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prevail Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shoreline, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2016; 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.