Unknown Individual – Physical Therapist, NPI 1710936679

Unknown Individual is a healthcare provider. based in Centralia, Washington. specializing in Physical Therapist. They hold a License No. PT00005068 (WA). The NPI Number for Unknown Individual is 1710936679

Main info

Organization
Inactive
37 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710936679
Phone
(360) 736-0699
Address
1510 KRESKY AVE
Deactivation Date
17 January 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1989 (37 years ago)
PAC ID
5395717011
Professional Enrollment ID
I20040813000030
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1510, Kresky Avenue, Centralia, Lewis County, Washington, 98531, United States

    CENTRALIA, WA 985318980

    Phone: (360) 736-0699

    Fax: (360) 736-0324

    Type: Location

  • Centralia Post Office, South Poplar Street, Wamac, Centralia, Marion County, Illinois, 62801, United States

    CENTRALIA, WA 985310700

    Phone: (360) 736-0699

    Fax: (360) 736-0324

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 98531)

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Provider's Procedures

Unknown Individual performs procedures in Physical Therapist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PHYSICAL THERAPYWA97110Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes33834

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1710936679.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's primary classification?
Physical Therapist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Centralia, Washington as a primary anchor for Unknown Individual unless the record lists multiple sites.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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