NPIMap

Organization Active NPI

Pt4Golfllc

  • Physical Therapist
  • Kirkland, WA
National Provider Identifier
1932224003
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7490 Issued in WA
Legal business name
PT4GOLFLLC
Practice address
12449 83Rd PL NE
Kirkland, WA 98034-2570
Phone
(425) 820-2810
Fax
(425) 487-2804
NPI assigned
Mar 20, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Glenn Mark Libman, PT
Title
Owner
Phone
(425) 820-2810

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 7490 WA Primary

Addresses

Primary practice location

12449 83Rd PL NE
Kirkland, WA 98034-2570

Mailing address

12449 83Rd PL NE
Kirkland, WA 98034-2570
Phone (425) 820-2810

Other names 1

  • PT4GOLF Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1932224003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12449 83RD PL NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342570",
            "telephone_number": "425-820-2810",
            "fax_number": "425-487-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12449 83RD PL NE",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980342570",
            "telephone_number": "425-820-2810",
            "fax_number": "425-487-2804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PT4GOLFLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LIBMAN",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-820-2810",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "7490",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PT4GOLF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kirkland, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.