Organization Active NPI

Three Rivers Physical Therapy PC

  • Physical Therapist
  • Kennewick, WA
National Provider Identifier
1801964291
Registry record updated May 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00007246 Issued in WA
Legal business name
THREE RIVERS PHYSICAL THERAPY PC
Practice address
2620 S Williams PL
Suite 110
Kennewick, WA 99338-1867
Phone
(509) 737-0333
Fax
(509) 737-0355
NPI assigned
Dec 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2017

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

Authorized official

Name
Mr. Rob Earle Kennell, MPT, OCANPI 1184710873
Title
Owner
Phone
(509) 737-0333

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 PT00007246 WA Primary

Addresses

Primary practice location

2620 S Williams PL
Suite 110
Kennewick, WA 99338-1867

Mailing address

2620 S Williams PL
Suite 110
Kennewick, WA 99338-1867
Phone (509) 737-0333

Other identifiers 1

IdentifierTypeStateIssuer
7133929MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041116001130 WA Part B Supplier - Clinic/Group Practice 1355305657 Receives reassigned benefits from 3 practitioners
Practice locations: Kennewick, WA

National Provider Directory

National Provider Directory

Locations

2620 S Williams Pl
Ste 110
Kennewick, WA 99338
Phone (509) 349-3010

Practitioners & affiliated clinicians

Practitioners 3

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": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493769600000",
    "number": "1801964291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 S WILLIAMS PL",
            "address_2": "SUITE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993381867",
            "telephone_number": "509-737-0333",
            "fax_number": "509-737-0355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 S WILLIAMS PL",
            "address_2": "SUITE 110",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993381867",
            "telephone_number": "509-737-0333",
            "fax_number": "509-737-0355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2017-05-03",
        "status": "A",
        "authorized_official_last_name": "KENNELL",
        "authorized_official_first_name": "ROB",
        "authorized_official_middle_name": "EARLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-737-0333",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, OCA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7133929",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennewick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2017; 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.