Active NPI
Jacob Jake Cruz
- Physical Therapist
- Lynnwood, WA
National Provider Identifier
1003358276
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT60620370
- Practice address
- 16520 Larch Way Unit Q2
Lynnwood, WA 98037-8129 - Phone
- (706) 832-8632
- NPI assigned
- Nov 4, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT60620370 | WA | Primary |
Addresses
Primary practice location
16520 Larch Way Unit Q2
Lynnwood, WA 98037-8129
Mailing address
16520 Larch Way Unit Q2
Lynnwood, WA 98037-8129
Phone (706) 832-8632
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT60620370 | WA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478217600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478217600000",
"number": "1003358276",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16520 LARCH WAY UNIT Q2",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980378129",
"telephone_number": "706-832-8632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16520 LARCH WAY UNIT Q2",
"city": "LYNNWOOD",
"state": "WA",
"postal_code": "980378129",
"telephone_number": "706-832-8632"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "JACOB JAKE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-04",
"last_updated": "2016-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WA",
"license": "PT60620370",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynnwood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.