Individual provider Active NPI

Ellen Sumner Hornbeak, PT, DPT

  • Physical Therapist
  • Longview, WA
National Provider Identifier
1891291910
Registry record updated Nov 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60903963 Issued in WA
Practice address
200 Triangle Shopping Ctr Ste 270
Longview, WA 98632
Phone
(360) 501-3750
Fax
(360) 501-3755
NPI assigned
Apr 5, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 62610 OR
Physical Therapist 225100000X PT60903963 WA Primary

Addresses

Primary practice location

200 Triangle Shopping Ctr Ste 270
Longview, WA 98632

Mailing address

4712 NE 13TH CT
Vancouver, WA 98663-6309
Phone (281) 620-7869

Other practice location 1

319 NE Russet St
Portland, OR 97211-2815
Phone (503) 289-5571

Other practice location 2

4805 NE Glisan St
Portland, OR 97213-2933
Phone (503) 215-5945

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
62610ORMDPhysical Therapist

NPI Registry JSON

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1891291910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 NE 13TH CT",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986636309",
            "telephone_number": "281-620-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 TRIANGLE SHOPPING CTR STE 270",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "98632",
            "telephone_number": "360-501-3750",
            "fax_number": "360-501-3755"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "319 NE Russet St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972112815",
            "country_code": "US",
            "telephone_number": "503-289-5571",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4805 NE Glisan St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972132933",
            "country_code": "US",
            "telephone_number": "503-215-5945",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HORNBEAK",
        "first_name": "ELLEN",
        "middle_name": "SUMNER",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-05",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "62610",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60903963",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.