520 Physical Therapy, LLC
Organization Active NPI Physical Therapy Clinic/Center · Bellevue, WA
NPI 1740864982 · NPPES record last updated May 12, 2021
Key facts
- NPI
- 1740864982
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- 520 PHYSICAL THERAPY, LLC
- Practice address
- 13112 NE 20TH St Ste 400
Bellevue, WA 98005-2045 - Phone
- (206) 693-9929
- Fax
- (206) 922-8909
- NPI assigned
- May 12, 2021
- Organization subpart
- No
Authorized official
- Name
- Walston Zachary Smith, DPT
- Title
- Co-Owner
- Phone
- (206) 693-9929
Practitioners 32
-
Tara Ahlf, DPT
-
Kelly Ann McCracken Musselman, PT, DPT, LAT, ATC
-
Hannah Marie Miller, PT, DPT
-
Ryan Scully Dixon, DPT
-
Rachel Nilsson, PT, DPT
-
Walston Zachary Smith, PT, DPT
-
Alex James Feller Davies, PT, DPT, CSCS
-
Andrew D Brown, DPT
-
Nyrene Buford, DPT
-
Zachary C Collins, DPT
-
Clay Fiscus, PT, DPT
-
Anthony Trinh, DPT
-
Shu Chin Tseng, DPT
-
Noelle E White, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210811003818 | WA | Part B Supplier - Physical/Occupational Therapy Group in Private Practice | 2062816168 |
Receives reassigned benefits from 11 practitioners Practice locations: Bellevue, WA |
National Provider Directory
Locations
13112 NE 20th St
Ste 400
Bellevue, WA 98005
Phone (253) 218-9539
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Yes |
Addresses
Primary practice location
13112 NE 20TH St Ste 400
Bellevue, WA 98005-2045
Mailing address
26431 233Rd Ave SE
Maple Valley, WA 98038
Phone (206) 693-9929
Other names
- HIDEF Physical Therapy
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.