NPIMap

Organization Active NPI

Javaman PS

Doing business as Fyzical Therapy & Balance Centers

  • Physical Therapy Clinic/Center
  • Bellingham, WA
National Provider Identifier
1841255502
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
601822178 Issued in WA
Legal business name
JAVAMAN PS
Doing business as
Fyzical Therapy & Balance Centers
Practice address
2075 Barkley Blvd
Ste 200
Bellingham, WA 98226-6696
Phone
(360) 733-4008
Fax
(360) 733-4064
NPI assigned
Apr 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Authorized official

Name
Mr. Eric David Short-Miller, PTNPI 1710959143
Title
Owner Vice President
Phone
(360) 733-4008

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X 601822178 WA Primary

Addresses

Primary practice location

2075 Barkley Blvd
Ste 200
Bellingham, WA 98226-6696

Mailing address

2075 Barkley Blvd
Ste 200
Bellingham, WA 98226-6696
Phone (360) 733-4008

Other identifiers 2

IdentifierTypeStateIssuer
7087836MedicaidWA
0118842OtherWALABOR AND INDUSTRY

Other names 1

  • Fyzical Therapy & Balance Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000338 WA Part B Supplier - Clinic/Group Practice 1456265263 Receives reassigned benefits from 19 practitioners
Practice locations: Bellingham, WA

National Provider Directory

National Provider Directory
Tax ID family
Performance Physical Therapy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

  • Javaman PS

    dba Pacific Northwest Rehab & Diagnostics

    • Speech-Language Pathologist
    • Bellingham, WA
    • NPI 1730886466
    NPD tax ID

Locations

1616 Cornwall Ave
Ste B
Bellingham, WA 98225
Phone (360) 714-0870

2075 Barkley Blvd
Ste 200
Bellingham, WA 98226
Phone (360) 733-4008

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1145318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1841255502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 BARKLEY BLVD",
            "address_2": "STE 200",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982266696",
            "telephone_number": "360-733-4008",
            "fax_number": "360-733-4064"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 BARKLEY BLVD",
            "address_2": "STE 200",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982266696",
            "telephone_number": "360-733-4008",
            "fax_number": "360-733-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAVAMAN PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-18",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "SHORT-MILLER",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER VICE PRESIDENT",
        "authorized_official_telephone_number": "360-733-4008",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "601822178",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7087836",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRY",
            "identifier": "0118842",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fyzical Therapy & Balance Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fyzical Therapy & Balance Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellingham, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; 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.