Individual provider Active NPI

Martha Elizabeth Glenn, DPT

  • Physical Therapist
  • Bonney Lake, WA
National Provider Identifier
1154553451
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60093163 Issued in WA
Practice address
19820 Sr 410 E
Suite 201
Bonney Lake, WA 98391-6377
Phone
(253) 863-7510
Fax
(253) 863-5970
NPI assigned
Aug 20, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60093163 WA Primary

Addresses

Primary practice location

19820 Sr 410 E
Suite 201
Bonney Lake, WA 98391-6377

Mailing address

PO Box 2170
Sumner, WA 98390-0480
Phone (253) 863-7510

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091021000420 WA Practitioner - Physical Therapist in Private Practice 8820135072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Multicare Health SystemGroup PAC ID 7719899897, 2,312 clinicians

Practice addresses (Care Compare)

3209 S 23Rd St
Suite 100
Tacoma, WA 98405-1602
Phone (253) 459-8174

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT60093163WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System CurrentSince Sep 15, 2018 Accepting new patients
Multicare Health System CurrentSince Sep 15, 2018 Accepting new patients
Multicare Health System Current Accepting new patients
PT Solutions Management, LLC Physical Therapist Past Accepting new patients
Apple Physical Therapy LLC Physical Therapist Past Accepting new patients

Locations

202 N Division St
Ste 200
Auburn, WA 98001
Phone (253) 333-1637

4700 Point Fosdick Dr
Ste 104
Gig Harbor, WA 98335
Phone (253) 459-7590

222 State Ave N
Kent, WA 98030
Phone (253) 372-7680

3209 S 23rd St
Ste 100
Tacoma, WA 98405
Phone (253) 459-6999

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1250726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1250726400000",
    "number": "1154553451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2170",
            "city": "SUMNER",
            "state": "WA",
            "postal_code": "983900480",
            "telephone_number": "253-863-7510",
            "fax_number": "253-840-6340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19820 SR 410 E",
            "address_2": "SUITE 201",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916377",
            "telephone_number": "253-863-7510",
            "fax_number": "253-863-5970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "MARTHA",
        "middle_name": "ELIZABETH",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-20",
        "last_updated": "2009-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60093163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bonney Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.