Active NPI
McKenzie Mya Schultz
- Physical Therapy Assistant
- Kent, WA
National Provider Identifier
1093412108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.008915
- Practice address
- 25012 104TH Ave SE Ste C
Kent, WA 98030-2821 - Phone
- (253) 499-9049
- NPI assigned
- Feb 9, 2023
- Sex
- Female
- Sole proprietor
- No
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 Therapy Assistant | 225200000X | 160.008915 | IL | Primary |
Addresses
Primary practice location
25012 104TH Ave SE Ste C
Kent, WA 98030-2821
Mailing address
2720 S Highland Ave Apt 417
Lombard, IL 60148-5393
Phone (815) 412-4280
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| EAV826943729 | Other | IL | BCBS |
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 |
|---|---|---|---|
| 160.008915 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1675900800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675900800000",
"number": "1093412108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2720 S HIGHLAND AVE APT 417",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601485393",
"telephone_number": "815-412-4280"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "25012 104TH AVE SE STE C",
"city": "KENT",
"state": "WA",
"postal_code": "980302821",
"telephone_number": "253-499-9049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHULTZ",
"first_name": "MCKENZIE",
"middle_name": "MYA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-09",
"last_updated": "2023-02-09",
"certification_date": "2023-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.008915",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "EAV826943729",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.