Sports Lab & Physical Therapy, PLLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

SPORTS LAB & PHYSICAL THERAPY, PLLC

Practice address

12403 E 1St Ave
Spokane Valley, WA 99216-0702

Phone

(509) 370-7597

Fax

(509) 418-0572

NPI assigned

May 22, 2023

Organization subpart

No

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

Authorized official

Name

Leandro M Bastos, PT, DPTNPI 1679045546

Title

Physical Therapist

Phone

(562) 212-8477

Specialties & licenses 1

Addresses

Other names 2

• Sports Lab Doing business as
• Sports Lab & PT Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Leandro Modenese Bastos, PT DPT

  • Physical Therapist
  • Spokane Valley, WA
  • NPI 1679045546
  Medicare reassignment Care Compare group NPD Authorized official
• Rebecca Gadbery, PT, DPT ATC

  • Physical Therapist
  • Paris, TX
  • NPI 1124411434

  WA

  Medicare reassignment Care Compare group
• Michelle Lundgren, DPT

  • Physical Therapist
  • Sammamish, WA
  • NPI 1487265377
  Medicare reassignment

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684713600000",
    "number": "1972295848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4915 W ROSEWOOD AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992083740",
            "telephone_number": "562-212-8477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12403 E 1ST AVE",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992160702",
            "telephone_number": "509-370-7597",
            "fax_number": "509-418-0572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTS LAB & PHYSICAL THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-20",
        "status": "A",
        "authorized_official_last_name": "BASTOS",
        "authorized_official_first_name": "LEANDRO",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "562-212-8477",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sports Lab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sports Lab & PT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Spokane Wellness Massage, LLC
• Elicia A Spotts, LMHC
• Amanda Spriggs, LPC LADC
• Abigail Lynette Springer
• Peter Springs, CPO
• Sarah Sprunk, LMHC, LPC

• Physical Therapist in Spokane Valley, WA
• Providers in Spokane Valley, WA by specialty
• Physical Therapist in Washington

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