Moses Lake Sports Physical Therapy, PS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT00005408 Issued in WA

Legal business name

MOSES LAKE SPORTS PHYSICAL THERAPY, PS

Practice address

515 N Stratford Rd
Moses Lake, WA 98837-1572

Phone

(509) 766-4277

Fax

(509) 766-4280

NPI assigned

Mar 20, 2007

Last updated

Apr 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Randy C Bruce, MSPTNPI 1326149667

Title

Physical Therapist

Phone

(509) 766-4277

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 6

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.

• Randy Clair Bruce, MSPT

  • Physical Therapist
  • Moses Lake, WA
  • NPI 1326149667
  Medicare reassignment Care Compare group NPD Authorized official
• Joshua Lawrence Bruce, DPT

  • Physical Therapist
  • Moses Lake, WA
  • NPI 1942541461
  Medicare reassignment Care Compare group NPD
• Adam McCall Coulson, DPT

  • Physical Therapist
  • Moses Lake, WA
  • NPI 1912671405
  Medicare reassignment NPD
• Jacob Francis Bruce, DPT

  • Physical Medicine & Rehabilitation Physician
  • Moses Lake, WA
  • NPI 1780220269
  NPD
• Erin K Lewis, PT

  • Physical Therapist
  • Moses Lake, WA
  • NPI 1841532801
  NPD (past)
• Bruce Michael Jacob, D.P.M.

  • Primary Podiatric Medicine Podiatrist
  • West Bloomfield, MI
  • NPI 1710066881
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1912022658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 N STRATFORD RD",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371572",
            "telephone_number": "509-766-4277",
            "fax_number": "509-766-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 N STRATFORD RD",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371572",
            "telephone_number": "509-766-4277",
            "fax_number": "509-766-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOSES LAKE SPORTS PHYSICAL THERAPY, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "BRUCE",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "509-766-4277",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00005408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "193527700",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORK HARDENING",
            "identifier": "51945",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7062011",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moses Lake Operations LLC (Avamere at Moses Lake)
• Moses Lake Orthodontics LLC
• Moses Lake Pediatric Dentistry
• Moses Lake Pediatric Dentistry
• Moses Lake School District
• Harold Scott Mounts, ARNP
• Zackery Muck
• Pegi Mueller, BA
• Haron E Mulamba, OTR
• Bethany Mulder, DO

• Physical Therapist in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Physical Therapist in Washington

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