NPIMap

Organization Active NPI

Creekside Physical Therapy, PLLC

  • Physical Therapist
  • Yakima, WA
National Provider Identifier
1922071455
Registry record updated Jul 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CREEKSIDE PHYSICAL THERAPY, PLLC
Practice address
4205 Castlevale Rd
Yakima, WA 98908-5603
Phone
(509) 576-0100
Fax
(509) 576-0101
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2023

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

Authorized official

Name
Jason Rice
Title
Billing Agent
Phone
(509) 952-3134

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

4205 Castlevale Rd
Yakima, WA 98908-5603

Mailing address

4205 Castlevale Rd
Yakima, WA 98908-5603
Phone (509) 576-0100

Other practice location 1

3908 Creekside Loop
Yakima, WA 98902-4877
Phone (509) 576-0100

Other identifiers 5

IdentifierTypeStateIssuer
800489OtherWAHARFFORD LIFE INSURANCE
7123987MedicaidWA
0200730OtherWALABOR AND INDUSTRIES
106263300OtherWAOFFICE OF WORKERS COMP
8940288OtherWACRIME VICTIMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040621001612 WA Part B Supplier - Clinic/Group Practice 5294710562 Receives reassigned benefits from 8 practitioners
Practice locations: Yakima, WA

National Provider Directory

National Provider Directory

Locations

3908 Creekside Loop
Yakima, WA 98902
Phone (509) 576-0100

3902 Creekside Loop
Ste 128
Yakima, WA 98902
Phone (509) 576-0100

3908 Creekside Loop
Ste 120
Yakima, WA 98902
Phone (509) 575-0100

4205 Castlevale Rd
Yakima, WA 98908
Phone (509) 576-0100

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": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1688601600000",
    "number": "1922071455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 CASTLEVALE RD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989085603",
            "telephone_number": "509-576-0100",
            "fax_number": "509-576-0101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4205 CASTLEVALE RD",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989085603",
            "telephone_number": "509-576-0100",
            "fax_number": "509-576-0101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3908 Creekside Loop",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989024877",
            "country_code": "US",
            "telephone_number": "509-576-0100",
            "fax_number": "509-576-0101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CREEKSIDE PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2023-07-06",
        "certification_date": "2023-07-06",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "509-952-3134"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARFFORD LIFE INSURANCE",
            "identifier": "800489",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7123987",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0200730",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE OF WORKERS COMP",
            "identifier": "106263300",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8940288",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; 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.