NPIMap

Organization Active NPI

Martha Lake Physical Therapy Inc

Doing business as Axis Physical Therapy Inc

  • Physical Therapist
  • Lynnwood, WA
National Provider Identifier
1104265412
Registry record updated Jun 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MARTHA LAKE PHYSICAL THERAPY INC
Doing business as
Axis Physical Therapy Inc
Practice address
16406 7TH PL W
Lynnwood, WA 98037-8100
Phone
(425) 672-2910
Fax
(425) 778-1872
NPI assigned
Jun 19, 2013
Last updated
Jun 19, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2013

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

Authorized official

Name
Jeffrey A Waldron, DPTNPI 1396793667
Title
Ceo
Phone
(425) 672-2910

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

16406 7TH PL W
Lynnwood, WA 98037-8100

Mailing address

21009 76TH Ave W
C/O Axis Physical Therapy
Edmonds, WA 98026-7126
Phone (425) 672-2910

Other names 1

  • AXIS PHYSICAL THERAPY INC Doing business as

National Provider Directory

National Provider Directory

Locations

16406 7th Pl W
Lynnwood, WA 98037
Phone (425) 245-8547

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1371600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371600000000",
    "number": "1104265412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21009 76TH AVE W",
            "address_2": "C/O AXIS PHYSICAL THERAPY",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267126",
            "telephone_number": "425-672-2910",
            "fax_number": "425-778-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16406 7TH PL W",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980378100",
            "telephone_number": "425-672-2910",
            "fax_number": "425-778-1872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTHA LAKE PHYSICAL THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-19",
        "last_updated": "2013-06-19",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "425-672-2910",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AXIS PHYSICAL THERAPY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 19, 2013; 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.