NPIMap

Organization Active NPI

Redhead Rehab PLLC

Doing business as Redhead PT

  • Physical Therapy Clinic/Center
  • Newcastle, WA
National Provider Identifier
1952961419
Registry record updated Jan 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
REDHEAD REHAB PLLC
Doing business as
Redhead PT
Redhead Rehabilitation
Practice address
7215 116TH Ave SE
Newcastle, WA 98056-1102
Phone
(360) 474-3192
Fax
(425) 278-0628
NPI assigned
Jun 17, 2019
Last updated
Jan 31, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2020

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

Authorized official

Name
Kathleen Maura Koenig, PT, MBANPI 1992844534
Title
Owner
Phone
(360) 474-3192

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

7215 116TH Ave SE
Newcastle, WA 98056-1102

Mailing address

7215 116TH Ave SE
Newcastle, WA 98056-1102
Phone (360) 474-3192

Other names 2

  • Redhead PT Doing business as
  • Redhead Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200129002904 WA Part B Supplier - Clinic/Group Practice 3971833567 Receives reassigned benefits from 1 practitioner
Practice locations: Newcastle, WA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1560729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580428800000",
    "number": "1952961419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7215 116TH AVE SE",
            "city": "NEWCASTLE",
            "state": "WA",
            "postal_code": "980561102",
            "telephone_number": "360-474-3192",
            "fax_number": "425-278-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7215 116TH AVE SE",
            "city": "NEWCASTLE",
            "state": "WA",
            "postal_code": "980561102",
            "telephone_number": "360-474-3192",
            "fax_number": "425-278-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDHEAD REHAB PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-17",
        "last_updated": "2020-01-31",
        "certification_date": "2020-01-31",
        "status": "A",
        "authorized_official_last_name": "KOENIG",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "MAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-474-3192",
        "authorized_official_credential": "PT, MBA"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Redhead PT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Redhead PT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Redhead Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newcastle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2020; 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.