NPIMap

Organization Active NPI

Provail

  • Rehabilitation Clinic/Center
  • Seattle, WA
National Provider Identifier
1871857946
Registry record updated Jul 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
OT60281347 Issued in WA
Legal business name
PROVAIL
Practice address
12550 Aurora Ave N
Seattle, WA 98133-8036
Phone
(206) 363-7303
NPI assigned
Jul 3, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2012

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

Authorized official

Name
Michael Hatzenbeler
Title
Ceo
Phone
(206) 826-1044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X OT60281347 WA Primary

Addresses

Primary practice location

12550 Aurora Ave N
Seattle, WA 98133-8036

Mailing address

12550 Aurora Ave N
Seattle, WA 98133-8036
Phone (206) 363-7303

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Outpatient physical therapy / speech pathology certification: CCN 506571

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PROVAIL
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Nov 18, 1997
Last certification
Mar 10, 2021
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
12550 Aurora Avenue North
Seattle, WA 98133

National Provider Directory

National Provider Directory
Tax ID family
Provail Dental Clinic3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

12550 Aurora Ave N
Seattle, WA 98133
Phone (206) 363-7303

Practitioners & affiliated clinicians

Practitioners 11

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": "1341273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341273600000",
    "number": "1871857946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12550 AURORA AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338036",
            "telephone_number": "206-363-7303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12550 AURORA AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981338036",
            "telephone_number": "206-363-7303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVAIL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-03",
        "last_updated": "2012-07-03",
        "status": "A",
        "authorized_official_last_name": "HATZENBELER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-826-1044"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "WA",
            "license": "OT60281347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.