NPIMap

Organization Active NPI

BDB Rehabilitation PC

  • Physical Therapist
  • Puyallup, WA
National Provider Identifier
1760181879
Registry record updated Feb 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BDB REHABILITATION PC
Practice address
13305 94TH Ave E
Puyallup, WA 98373-6106
Phone
(800) 444-6845
Fax
(479) 478-2852
NPI assigned
Feb 27, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2023

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

Authorized official

Name
Misty S Wilson
Title
Contract & Credentialing Specialist
Phone
(972) 372-6779

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

13305 94TH Ave E
Puyallup, WA 98373-6106

Mailing address

2601 Network Blvd Ste 102
Frisco, TX 75034-9092
Phone (972) 372-6779

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240313004065 WA Part B Supplier - Clinic/Group Practice 7911393319 Receives reassigned benefits from 8 practitioners
2 other NPIs on this enrollment
Practice locations: Marysville, WA; Puyallup, WA; Vancouver, WA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
BDB Rehabilitation PC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

301 SE 136th Ave
Vancouver, WA 98684
Phone (360) 869-3613

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1760181879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 NETWORK BLVD STE 102",
            "city": "FRISCO",
            "state": "TX",
            "postal_code": "750349092",
            "telephone_number": "972-372-6779",
            "fax_number": "479-668-0872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13305 94TH AVE E",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983736106",
            "telephone_number": "800-444-6845",
            "fax_number": "479-478-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BDB REHABILITATION PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CONTRACT & CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "972-372-6779"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Puyallup, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; 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.