NPIMap

Organization Active NPI

Evergreen Physical Therapy PS

Doing business as Evergreen Physical Therapy

  • Physical Therapist
  • Mount Vernon, WA
National Provider Identifier
1891780151
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
EVERGREEN PHYSICAL THERAPY PS
Doing business as
Evergreen Physical Therapy
Practice address
2226 Market St Ste C
Mount Vernon, WA 98273-5451
Phone
(360) 428-6677
Fax
(360) 428-7635
NPI assigned
Sep 13, 2005
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Mr. Joshua R Smith
Title
Office Admin
Phone
(360) 428-6677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

2226 Market St Ste C
Mount Vernon, WA 98273-5451

Mailing address

PO Box 1789
Mount Vernon, WA 98273-1789
Phone (360) 428-6677

Other names 2

  • Evergreen Physical Therapy Doing business as
  • Jay A. Smith Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

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": "1126569600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1891780151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1789",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982731789",
            "telephone_number": "360-428-6677",
            "fax_number": "360-428-7635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2226 MARKET ST STE C",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982735451",
            "telephone_number": "360-428-6677",
            "fax_number": "360-428-7635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PHYSICAL THERAPY PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-13",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OFFICE ADMIN",
        "authorized_official_telephone_number": "360-428-6677",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jay A. Smith",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2024; 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.