NPIMap

Organization Active NPI

Family Physical Therapy and Sports Rehabilitation

  • Physical Therapist
  • Morton, WA
National Provider Identifier
1992808240
Registry record updated Sep 25, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
00002616 Issued in WA
Legal business name
FAMILY PHYSICAL THERAPY AND SPORTS REHABILITATION
Practice address
148 Division Street
Morton, WA 98356
Phone
(360) 496-5335
Fax
(360) 496-5181
NPI assigned
Sep 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2007

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

Authorized official

Name
Mr. Elee Marcel Fairhart, P.TNPI 1326044629
Title
President/Owner
Phone
(360) 496-5335

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 00002616 WA Primary

Addresses

Primary practice location

148 Division Street
Morton, WA 98356

Mailing address

PO Box 9
Morton, WA 98356-0009
Phone (360) 496-5335

Other identifiers 1

IdentifierTypeStateIssuer
7013352MedicaidWA

National Provider Directory

National Provider Directory

Locations

2020 Borst Ave
Centralia, WA 98531
Phone (360) 367-6446

Practitioners 10

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": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1992808240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9",
            "city": "MORTON",
            "state": "WA",
            "postal_code": "983560009",
            "telephone_number": "360-496-5335",
            "fax_number": "360-496-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 DIVISION STREET",
            "city": "MORTON",
            "state": "WA",
            "postal_code": "98356",
            "telephone_number": "360-496-5335",
            "fax_number": "360-496-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY PHYSICAL THERAPY AND SPORTS REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "FAIRHART",
        "authorized_official_first_name": "ELEE",
        "authorized_official_middle_name": "MARCEL",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "360-496-5335",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "00002616",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7013352",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Morton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; 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.