NPIMap

Organization Active NPI

Harbor Physical Therapy Services, PS

  • Physical Therapist
  • Aberdeen, WA
National Provider Identifier
1972512358
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
HARBOR PHYSICAL THERAPY SERVICES, PS
Practice address
220 W 1St St
Aberdeen, WA 98520-6216
Phone
(360) 533-3853
Fax
(360) 533-3310
NPI assigned
Aug 5, 2006
Last updated
Oct 11, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2007

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

Authorized official

Name
Mrs. Jill Marie Wilson, PTNPI 1437168887
Title
President
Phone
(360) 533-3853

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 1

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

Addresses

Primary practice location

220 W 1St St
Aberdeen, WA 98520-6216

Mailing address

220 W 1St St
Aberdeen, WA 98520-6216

Other identifiers 2

IdentifierTypeStateIssuer
0015007OtherWALABOR AND INDUSTRIES
7921703MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000692 WA Part B Supplier - Clinic/Group Practice 4880581677 Receives reassigned benefits from 4 practitioners
Practice locations: Aberdeen, WA; Olympia, WA; Shelton, WA

National Provider Directory

National Provider Directory

Locations

220 W 1st St
Aberdeen, WA 98520
Phone (360) 533-3853

2300 Kati Ct
Ste B
Shelton, WA 98584
Phone (360) 426-5903

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/25026/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192060800000",
    "number": "1972512358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 W 1ST ST",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985206216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 W 1ST ST",
            "city": "ABERDEEN",
            "state": "WA",
            "postal_code": "985206216",
            "telephone_number": "360-533-3853",
            "fax_number": "360-533-3310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR PHYSICAL THERAPY SERVICES, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-10-11",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "JILL",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-533-3853",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "0015007",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7921703",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aberdeen, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2007; 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.