Individual provider Active NPI

Eddy Leonard Robertson, PT

  • Physical Therapist
  • Pullman, WA
National Provider Identifier
1891751087
Registry record updated Jul 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00007122 Issued in WA
Practice address
1620 SE Summit CT
Pullman, WA 99163-5519
Phone
(509) 332-5106
Fax
(509) 334-5723
NPI assigned
Apr 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00007122 WA Primary

Addresses

Primary practice location

1620 SE Summit CT
Pullman, WA 99163-5519

Mailing address

803 Line Street
Box 28
Colton, WA 99113
Phone (509) 229-3979

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240506004048 WA Practitioner - Physical Therapist in Private Practice 2567802606 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Washington School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital District 1-a of Whitman CountyGroup PAC ID 8325934987, 86 clinicians

Practice addresses (Care Compare)

405 NE Stadium Way
Pullman, WA 99163-3825
Phone (509) 338-0650

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital District #1-a of Whitman County Physical Therapist CurrentSince Mar 1, 2024 Accepting new patients
Public Hospital District #1-a of Whitman County CurrentSince Mar 1, 2024 Accepting new patients
Public Hospital District #1-a of Whitman County Past Accepting new patients
Public Hospital District # 1-a Past Accepting new patients

Locations

840 SE Bishop Blvd
Ste 103
Pullman, WA 99163
Phone (509) 336-7300

1620 SE Summit Ct
Pullman, WA 99163
Phone (509) 332-5106

825 SE Bishop Blvd
Ste 200
Pullman, WA 99163
Phone (509) 332-2517

405 NE Stadium Way
Pullman, WA 99163
Phone (509) 338-0650

835 SE Bishop Blvd
Pullman, WA 99163
Phone (509) 332-2541

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1891751087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 LINE STREET",
            "address_2": "BOX 28",
            "city": "COLTON",
            "state": "WA",
            "postal_code": "99113",
            "telephone_number": "509-229-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 SE SUMMIT CT",
            "city": "PULLMAN",
            "state": "WA",
            "postal_code": "991635519",
            "telephone_number": "509-332-5106",
            "fax_number": "509-334-5723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "EDDY",
        "middle_name": "LEONARD",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-25",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pullman, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.