NPIMap

Organization Active NPI

Orthosport Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Lynnwood, WA
National Provider Identifier
1750471538
Registry record updated Dec 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ORTHOSPORT PHYSICAL THERAPY LLC
Practice address
19217 36TH Ave W
Suite 102
Lynnwood, WA 98036-5751
Phone
(425) 670-9991
Fax
(425) 670-9995
NPI assigned
Oct 13, 2006
Last updated
Dec 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2015

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

Authorized official

Name
Thomas Diangelis, PT, DPTNPI 1871579144
Title
Owner
Phone
(425) 670-9991

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X PT00002005 WA
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

19217 36TH Ave W
Suite 102
Lynnwood, WA 98036-5751

Mailing address

19217 36TH Ave W
Suite 102
Lynnwood, WA 98036-5751
Phone (425) 670-9991

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450396800000",
    "number": "1750471538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19217 36TH AVE W",
            "address_2": "SUITE 102",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365751",
            "telephone_number": "425-670-9991",
            "fax_number": "425-670-9995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19217 36TH AVE W",
            "address_2": "SUITE 102",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980365751",
            "telephone_number": "425-670-9991",
            "fax_number": "425-670-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOSPORT PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-12-18",
        "status": "A",
        "authorized_official_last_name": "DIANGELIS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-670-9991",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "WA",
            "license": "PT00002005",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynnwood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2015; 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.