NPIMap

Organization Active NPI

Elite Physical Therapy Group, LLC

  • Physical Therapy Clinic/Center
  • Tacoma, WA
National Provider Identifier
1821256298
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
602832882 Issued in WA
Legal business name
ELITE PHYSICAL THERAPY GROUP, LLC
Practice address
223 140TH St S Ste 700
Tacoma, WA 98444-4549
Phone
(253) 531-5645
Fax
(253) 536-3467
NPI assigned
Jun 2, 2008
Last updated
Sep 20, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Trevor William Pettingill, MPTNPI 1033291075
Title
Physical Therapist/Clinic Owner
Phone
(253) 732-8116

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 Therapy Clinic/Center 261QP2000X 602832882 WA Primary

Addresses

Primary practice location

223 140TH St S Ste 700
Tacoma, WA 98444-4549

Mailing address

21707 103Rd Avenue CT E Ste B202
Graham, WA 98338-8308
Phone (253) 271-7339

Other practice location 1

5701 N 26th St
Tacoma, WA 98407-2408
Phone (253) 507-7450

Other practice location 2

19910 S Prairie Rd E
Bonney Lake, WA 98391-7901
Phone (253) 750-5997

Other practice location 3

9909 224th St E Unit 100B
Graham, WA 98338-7086
Phone (253) 780-4965

Other identifiers 2

IdentifierTypeStateIssuer
G8876026OtherMEDICARE PTAN #
2001745MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081008000132 WA Part B Supplier - Clinic/Group Practice 2668540337 Receives reassigned benefits from 17 practitioners
Practice locations: Bonney Lake, WA; Graham, WA; Tacoma, WA; University Place, WA

National Provider Directory

National Provider Directory

Locations

21707 103rd Avenue Ct E
Ste B202
Graham, WA 98338
Phone (253) 655-5841

15617 Pacific Ave S
Tacoma, WA 98444
Phone (253) 531-5645

223 140th St S
Ste 700
Tacoma, WA 98444
Phone (253) 531-5645

5701 N 26th St
Tacoma, WA 98407
Phone (253) 507-7450

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1821256298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21707 103RD AVENUE CT E STE B202",
            "city": "GRAHAM",
            "state": "WA",
            "postal_code": "983388308",
            "telephone_number": "253-271-7339",
            "fax_number": "253-655-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 140TH ST S STE 700",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984444549",
            "telephone_number": "253-531-5645",
            "fax_number": "253-536-3467"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5701 N 26th St",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "984072408",
            "country_code": "US",
            "telephone_number": "253-507-7450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "19910 S Prairie Rd E",
            "address_purpose": "LOCATION",
            "city": "Bonney Lake",
            "state": "WA",
            "postal_code": "983917901",
            "country_code": "US",
            "telephone_number": "253-750-5997",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9909 224th St E Unit 100B",
            "address_purpose": "LOCATION",
            "city": "Graham",
            "state": "WA",
            "postal_code": "983387086",
            "country_code": "US",
            "telephone_number": "253-780-4965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELITE PHYSICAL THERAPY GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "PETTINGILL",
        "authorized_official_first_name": "TREVOR",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/CLINIC OWNER",
        "authorized_official_telephone_number": "253-732-8116",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "602832882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN #",
            "identifier": "G8876026",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001745",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.