NPIMap

Organization Active NPI

Washougal Sport and Spine, Inc.

  • Physical Therapy Clinic/Center
  • Washougal, WA
National Provider Identifier
1871743526
Registry record updated Sep 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT00009023 Issued in WA
Legal business name
WASHOUGAL SPORT AND SPINE, INC.
Practice address
1700 Main
Suite 222
Washougal, WA 98671
Phone
(360) 904-9698
NPI assigned
Sep 30, 2008
Last updated
Sep 30, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2008

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

Authorized official

Name
Stephen M McCarthy, PTNPI 1982659686
Title
President/Owner
Phone
(360) 904-9698

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 PT00009023 WA Primary

Addresses

Primary practice location

1700 Main
Suite 222
Washougal, WA 98671

Mailing address

1700 Main
Suite 222
Washougal, WA 98671
Phone (360) 904-9698

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081022000644 WA Part B Supplier - Clinic/Group Practice 2163580929 Receives reassigned benefits from 7 practitioners
Practice locations: Washougal, WA

National Provider Directory

National Provider Directory

Locations

1700 Main St
Ste 136
Washougal, WA 98671
Phone (360) 835-5349

1700 Main St
Ste 222
Washougal, WA 98671
Phone (360) 835-5349

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222732800000",
    "number": "1871743526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 MAIN",
            "address_2": "SUITE 222",
            "city": "WASHOUGAL",
            "state": "WA",
            "postal_code": "98671",
            "telephone_number": "360-904-9698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 MAIN",
            "address_2": "SUITE 222",
            "city": "WASHOUGAL",
            "state": "WA",
            "postal_code": "98671",
            "telephone_number": "360-904-9698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WASHOUGAL SPORT AND SPINE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-30",
        "last_updated": "2008-09-30",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "360-904-9698",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WA",
            "license": "PT00009023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washougal, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2008; 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.