NPIMap

Organization Active NPI

Kitsap Physical Therapy LLC

  • Physical Therapist
  • Port Orchard, WA
National Provider Identifier
1811945900
Registry record updated Apr 7, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
602080097 Issued in WA
Legal business name
KITSAP PHYSICAL THERAPY LLC
Practice address
1880 Pottery Ave
Suite 100
Port Orchard, WA 98366-2518
Phone
(360) 895-9090
Fax
(360) 895-9089
NPI assigned
May 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2009

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

Authorized official

Name
Mr. John Robert Carlson, PT
Title
Owner
Phone
(360) 895-9090

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 602080097 WA Primary

Addresses

Primary practice location

1880 Pottery Ave
Suite 100
Port Orchard, WA 98366-2518

Mailing address

1880 Pottery Ave
Suite 100
Port Orchard, WA 98366-2518
Phone (360) 895-9090

Other identifiers 3

IdentifierTypeStateIssuer
0150495OtherWAWA STATE DEPT OF LABOR IN
DB8089OtherRR MEDICARE
7105166MedicaidWA

Other names 1

  • Kitsap Physical Therapy and Sports Clinics Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239062400000",
    "number": "1811945900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1880 POTTERY AVE",
            "address_2": "SUITE 100",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662518",
            "telephone_number": "360-895-9090",
            "fax_number": "360-895-9089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1880 POTTERY AVE",
            "address_2": "SUITE 100",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983662518",
            "telephone_number": "360-895-9090",
            "fax_number": "360-895-9089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITSAP PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-04",
        "last_updated": "2009-04-07",
        "status": "A",
        "authorized_official_last_name": "CARLSON",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-895-9090",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "602080097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA STATE DEPT OF LABOR IN",
            "identifier": "0150495",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DB8089",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7105166",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kitsap Physical Therapy and Sports Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Orchard, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; 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.